[Retrocardiac pheochromocytoma associated with a double carotid site. Diagnostic and therapeutic discussion]

A case of cardiac paraganglioma is reported in a 30 year old man operated two years previously for bilateral carotid body paraganglioma. Due to the persistence of high catecholamine levels in the superior vena cava, a cardiac localization, suspected on echocardiography, was confirmed by coronary angiography. MRI identified the exact site of the tumour in contact with the posterior surface of the left atrium and the great vessels of the base of the heart. Complete resection was performed via sternotomy. The adhesions to the great vessels and atrium and the retrocardiac site of the tumour required continuation of the operation under CPB with transection of the superior vena cava, aorta and pulmonary artery in order to achieve complete resection despite the hypervascular nature of the tumour. Postoperative collapse of peripheral resistance requiring 48 hours of adrenaline infusion demonstrated the immediate efficacy of the surgical operation. After a follow-up of four months, the blood pressure and catecholamine levels remained normal. The authors emphasise: the value of MRI for the topographic diagnosis of thoracic lesions, the association of a double carotid body paraganglioma and a mediastinal tumour, especially cardiac, which has already been reported in the literature and the availability of CPB in order to perform complete resection of these tumours with complete security in view of their intimate relations with cardiac cavities and the vessels of the base of the heart.