Imaging in functional posterior mediastinal ganglioneuroma presenting with catecholamine-induced dilated cardiomyopathy

Abstract Ganglioneuromas are rare, benign neural crest-derived tumors capable of secreting catecholamines and clinically mimicking more aggressive neoplasms such as paragangliomas. We present the case of a 35-year-old woman with paroxysmal hypertension, palpitations, and exertional dyspnea, found to have catecholamine-induced dilated cardiomyopathy and a posterior mediastinal mass. Imaging suggested a paraganglioma, but histopathological and immunohistochemical evaluation confirmed a functional ganglioneuroma. Following preoperative alpha-adrenergic blockade, complete surgical excision of the tumor led to resolution of symptoms, normalization of blood pressure, and significant improvement in cardiac function. This case emphasizes the importance of early recognition and multidisciplinary management of functional ganglioneuromas to prevent serious cardiovascular complications and ensure favorable outcomes.