CTICasesHypervascular Atrioventricular-Groove Lesion (Suspected Paraganglioma)
Imaging findings
Coronary CTA in a patient with chest pain and severe LAD stenosis shows a small enhancing, non-calcified hypervascular lesion near the atrioventricular groove that appeared in some phases to arise near an acute marginal artery, without prior sternotomy or intervention. Catheterization confirmed the LAD stenosis but did not clearly demonstrate the lesion or a feeding vessel. A comparison patient with a similar hypervascular lesion near a coronary artery and a hypervascular region around the carotid artery had an SDH-related paraganglioma syndrome, with the lesions intensely avid on F-DOPA PET.
Key takeaways
A small enhancing hypervascular cardiac lesion can be difficult to characterize on coronary CTA and may be missed at catheterization owing to motion and injection angles, with the differential including pseudoaneurysm, paraganglioma, hemangioma, and early angiosarcoma. Cardiac and atrioventricular-groove paragangliomas are rare, may occur in SDH-mutation multifocal paraganglioma syndromes, and are confirmed with F-DOPA PET, reminding that paragangliomas can occur in locations textbooks do not emphasize.
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