CTICasesMetastatic Paraganglioma
Imaging findings
A young patient with an SDHB mutation has a mediastinal (AP-window/subcarinal and right paratracheal) primary paraganglioma with widespread metastases, including numerous pulmonary and hepatic lesions, imaged from 2016 to recent studies. Most pulmonary metastases are unchanged over years, with only modest growth of the primary and some liver lesions, and specialized nuclear medicine studies (MIBG or a gallium-68 DOTATATE-type PET agent) show corresponding uptake.
Key takeaways
Paraganglioma in a characteristic mediastinal location can be widely metastatic yet remarkably indolent, with a patient surviving and stable over years. These tumors are associated with germline mutations (such as SDHB and related genes), warranting family screening with periodic chest and abdominal MRI, and functional imaging with MIBG or DOTATATE-based PET confirms the neuroendocrine nature and disease extent.
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