Fleischmann, Dominik

Forrester, Matthew D.

Ho, Michael Y.

Lee, David P.

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P U B L I S H E D B Y E L S E V I E R I N C . D O I : 1 0 . 1 0 1 6 / j . j c i n . 2 0 1 1 . 0 6 . 0 2 1IMAGES IN INTERVENTION
Coil Embolization of a Left Circumflex Feeder Branch
in a Patient With a Mediastinal Paraganglioma
Michael Y. Ho, MD,* Dominik Fleischmann, MD,† Matthew D. Forrester, MD,‡
David P. Lee, MD*
Stanford, CaliforniaMedic
t of C
levant
onarA 62-year-old man presented with several months
of fatigue, palpitations, and dyspnea on exertion. A
Holter monitor revealed a high burden of multifo-
cal premature ventricular contractions (110/h)
From the *Division of Cardiovascular Medicine, Stanford University
University Medical Center, Stanford, California; and the ‡Departmen
California. The authors have reported that they have no relationships re
Figure 1. Coronary Angiogram, CT, and PET
(A) Initial coronary angiogram: coronary angiography showing a la
plying a hypervascular mass. (B) Cardiac computed tomography (C
left atrium (LA) and the left pulmonary vein. (C) Fluoro-18-deoxyg
radiotracer uptake in the mediastinal mass. Ao  aorta; PA  pulmManuscript received January 6, 2011; revised manuscript received June 1, 201with a 9-beat run of nonsustained ventricular
tachycardia. Transthoracic echocardiogram showed
normal resting left ventricular systolic function
with no valvular abnormalities. On a stress echo-
al Center, Stanford, California; †Department of Radiology, Stanford
ardiothoracic Surgery, Stanford University Medical Center, Stanford,
to the contents of this paper to disclose.
rtuous vessel originating from the proximal left circumﬂex sup-
ximum intensity projection image showing mass adjacent to the
positron emission tomography (PET) imaging scan showing high
y artery.rge to
T): ma
lucose1, accepted June 14, 2011.
tonary
J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S , V O L . 4 , N O . 1 2 , 2 0 1 1
D E C E M B E R 2 0 1 1 : 1 3 4 5 – 6
Ho et al.
Coil Embolization of LCx Feeder Branch in Patient With Mediastinal Paraganglioma
1346cardiogram, the patient achieved 12 METs, 85% of maxi-
mum predicted heart rate, with no ischemic electrocar-
diogram findings or stress-induced wall motion abnormalities.
He had a short run of supraventricular tachycardia during
stress that spontaneously resolved. Due to progression of
his dyspnea, he was referred for coronary angiography,
which revealed no angiographic evidence of coronary
artery disease. However, a large tortuous vessel, originat-
ing from the proximal left circumflex artery, was visual-
ized coursing superiorly toward an enhancing extracar-
diac mass lesion (Fig. 1A). Contrast-enhanced computed
omography of the thorax revealed a 2.8  2.3  3.6 cm,
heterogeneous, hypervascular mass adjacent to the left
atrium and abutting the left superior pulmonary vein
(Fig. 1B). A positron emission tomography scan showed
the mass to be intensely radiotracer-avid with a standard
uptake value maximum of 21.3 (Fig. 1C). The treatment
strategy was to gain hemostatic control before surgical
Figure 2. Coronary Angiography and Intraoperative Photograph
(A) Intracoronary coil implantation: coronary angiography after implantation o
photograph demonstrating an intrapericardial mass involving left inferior pulmresection. The patient underwent percutaneous coronarycoil embolization of the tumor feeder branch with trans-
catheter placement of 9 platinum detachable coils (Mi-
croPlex Coil System, Terumo Medical, Somerset, New
Jersey) with dramatic reduction in distal blood flow (Fig. 2A).
The patient then underwent surgical resection via a left
thoracotomy. The pericardium was incised, revealing the
mass adjacent to the left inferior pulmonary vein at its
junction with the left atrium (Fig. 2B). Anatomic left
lower lobectomy was performed with en bloc resection of
the mass. Of note, intraoperative manipulation of the
mass resulted in severe hypertension, suggesting a func-
tional tumor. Pathology revealed a paraganglioma with
negative margins.
Reprint requests and correspondence: Dr. Michael Y. Ho,
Division of Cardiovascular Medicine, Stanford University Medical
Center, 300 Pasteur Drive, H2103, Stanford, California 94305-
in the tumor feeder vessel. (B) Intrapericardial mass: intraoperative
vein.f coils5218. E-mail: michael.y.ho@stanford.edu.


Coil Embolization of a Left Circumflex Feeder Branch in a Patient With a Mediastinal Paraganglioma 

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Coil Embolization of a Left Circumflex Feeder Branch in a Patient With a Mediastinal Paraganglioma

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