Transcatheter arterial embolization of coronary feeder vessels to primary cardiac paraganglioma: a case report

Background: A 71-year-old female with hypercholesterolaemia and pre-diabetes was referred for chest pain evaluation. Initial imaging suggested significant coronary artery disease but incidental lung and mediastinal masses raised concerns about malignancy. Case Summary: Further evaluation by PET, MRI, and biopsy led to the diagnosis of a synchronous primary cardiac paraganglioma and lung adenocarcinoma. There was significant vascular supply to the mediastinal mass from both coronary systems with moderate coronary artery disease. To manage surgical bleeding risks, the patient underwent transcatheter arterial embolization of the coronary feeder vessels followed by successful open resection of both mediastinal and pulmonary masses. Discussion: Primary cardiac tumours are rare. Primary cardiac paragangliomas are usually benign but can be difficult to manage. A multi-disciplinary approach is vital for successful treatment with PET, CT, and MRI imaging aiding the process. Transcatheter arterial embolization reduces tumour vascularity before surgery and potentially bleeding related complications.