CTICasesMediastinal Paraganglioma
Imaging findings
Contrast-enhanced CT shows a highly vascular, intensely enhancing ('blushing') soft-tissue mass located in the left superior mediastinum, nested within the branching origins of the aortic arch vessels. Gallium-68 DOTATATE PET/CT demonstrates intense, avid uptake within the mass, consistent with a somatostatin receptor-expressing neuroendocrine tumor.
Key takeaways
Paragangliomas of the mediastinum are rare neuroendocrine tumors that arise from chromaffin cells of the sympathetic or parasympathetic chains. They are highly vascular lesions that show intense contrast enhancement on CT and avid uptake on DOTATATE PET. Ectopic thyroid tissue and Castleman disease should also be considered in the differential diagnosis of intensely enhancing mediastinal masses.
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