CTICasesGiant Posterior Mediastinal Paraganglioma
Imaging findings
Radiograph shows a large opacity with a non-cervicothoracic sign and paravertebral air levels, indicating a posterior mediastinal and lung location in a patient with back pain and lower extremity paresthesias and weakness. CT shows an enormous hypervascular mass involving several vertebral levels with cord compression, extensive chest wall and mediastinal collateral vessels, and bony destruction. MRI shows internal vascularity, T2 hyperintensity, and marked delayed enhancement, and percutaneous biopsy suggested paraganglioma.
Key takeaways
Paragangliomas can rarely reach massive size and arise in the posterior mediastinum, appearing as intensely hypervascular, locally invasive masses with bony destruction and cord compression. Extensive multilevel arterial supply, including cross-midline recruitment, requires preoperative angiographic embolization, and identifying feeding chest wall collaterals from subclavian branches is important surgical information. Histology showed a Zellballen growth pattern with rare mitoses.
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