case_images: PMC2635122_01
case_images: Cardiac catheterization image: showing the "tumor blush" (denoted by "a") with neovascularization seen projecting from the left circumflex artery (arrow) to the "tumor blush."
case_images: 1757-1626-2-72-1.jpg
case_images: PMC2635122_01_1757-1626-2-72-1.jpg
case_images: F1
case_images: It did not show any obstruction in the coronary arteries, but did reveal a "tumor blush" with neovascularization seen projecting from the left circumflex artery to the "tumor blush". (Figure 1) Following the cardiac catheterization, patient had a CT scan of the chest to evaluate for any mass or tumor.
case_images: CT scan: image showing a solid and likely necrotic mass (arrows) extending posterior to the left atrium.
case_images: 1757-1626-2-72-2.jpg
case_images: PMC2635122_01_1757-1626-2-72-2.jpg
case_images: F2
case_images: The CT scan showed a 6 cm solid and likely necrotic mass beginning slightly anterior to the carina and extending caudally posterior to the left atrium. (Figure 2) No prior imaging was available for comparison.
case_images: Trans-esophageal echocardiogram: TEE shows a large mass, likely extrinsic to the heart, compressing the left atrium (LA). RA denotes Right Atrium; RV denotes Right Ventricle; LV denotes Left Ventricle; P denotes the Cardiac Paraganglioma.
case_images: 1757-1626-2-72-3.jpg
case_images: PMC2635122_01_1757-1626-2-72-3.jpg
case_images: F3
case_images: The TEE also showed the large mass, likely extrinsic to the heart, compressing the left atrium. (Figure 3) Finally, the patient underwent an open heart surgery for definitive diagnosis and management.
case_images: Biopsy from the cardiac mass: photomicrograph of the biopsy specimen taken from the tumor showing tumor cells arranged in a nest-like (Zellballen) pattern, in a background of thick collagenous stroma, separated by thin vascular network. (Original magnification x40; H&E stain).
case_images: 1757-1626-2-72-4.jpg
case_images: PMC2635122_01_1757-1626-2-72-4.jpg
case_images: F4