SUN-007 Rare Etiology of Chest Pain: Intrapericardial Paraganglioma

Abstract Disclosure: A. Chandora: None. K. Chandora: None. R. DeStefano: None. S.H. Fantaye: None. Case report: A middle aged African American male with subdural empyema with previous craniotomy complicated by seizures presented to the emergency room for a week-long history of chest pain that he describes as a “gas” sensation. The pain would last for up to 2 minutes and worsened with bending forward. There was associated dyspnea with the pain. His troponin was unremarkable, EKGs showed sinus bradycardia with TWIs in inferolateral leads. Cardiac Computed Tomography (CT) with angiography was performed to rule out coronary artery disease and found the patient had a juxtacardiac tumor. Subsequent cardiac MRI showed findings of 24 mm by 17 mm hypervascular tumor with recruitment of adjacent coronary arteries located between the visceral and parietal pericardium. These findings were suspicious for paraganglioma. Oncology and Cardiothoracic surgery services were consulted and recommended endocrinological workup prior to surgical intervention with plasma and urine Norepinephrine, normetanephrine, and metanephrines. Plasma metanephrines and normetanephrine were elevated past the upper limit of normal. Plasma Norepinephrine was found to be 2-3 times the upper limit of normal. On his visit to the endocrinology clinic, the patient denied any episodes of tachycardia, diaphoresis or other sympathetic responses but continued to have chest pain although it was right sided. For further workup patients are pending CT Copper 64 Dotatate scan, 24 hour urine metanephrines, and repeat serum metanephrines and norepinephrine levels. Discussion: Many clinicians are familiar with pheochromocytomas but paragangliomas also known as extra-adrenal paragangliomas occur at the same rate of 0.6/100,000 people. These rare chromaffin cell tumors can be functional and can be diagnosed by serum and urine metanephrines and location can be confirmed with imaging. Although patients with functional paragangliomas can be symptomatic with the classical triad of tachycardia, hypertension, and diaphoresis, many paragangliomas are discovered as incidental findings with the availability of imaging in healthcare systems. Mediastinal paragangliomas are exceedingly rare, compromising around 1-2% of all paragangliomas. Most of the mediastinal paragangliomas will occur within the left atrium wall. Our case does not have a definitive diagnosis of paraganglioma currently but it is meant to add mediastinal tumors, such as neuroendocrine tumors like paraganglioma, to the broad differential for clinicians with positional chest pain. Clinicians should also understand that patients with paragangliomas may not present with classical episodic symptoms or with essential hypertension and may present with incidental findings on imaging that will require proper workup and preoperative planning if resection is ultimately required for treatment. Presentation: Sunday, July 13, 2025