A case of successful management for spontaneous rupture of paraganglioma treated with preoperative transcatheter arterial embolization

TL;DR

A patient with a ruptured paraganglioma was successfully treated with preoperative embolization, controlling bleeding and blood pressure during surgery.

Contribution

This case demonstrates the efficacy of preoperative TAE in managing ruptured paragangliomas.

Findings

Urgent TAE successfully controlled intratumoral hemorrhage in a patient with ruptured PGL.

Post-TAE, catecholamine levels normalized and retroperitoneal hematoma resolved.

Elective surgery was performed safely with minimal bleeding and stable blood pressure.

Abstract

Tumors arising from catecholamine-producing chromophil cells in paraganglia are termed paragangliomas (PGLs), which biologically resemble pheochromocytomas (PCCs) that arise from the adrenal glands. Spontaneous rupture of a PGL is rare and can be fatal. Although elective surgery for ruptured PCCs after transcatheter arterial embolization (TAE) has been shown to provide good outcomes, the efficacy of TAE pretreatment for ruptured PGL remains unknown.

A 65-year-old female with hypertension and tachycardia was diagnosed with a 3-cm PGL located behind the inferior vena cava. The patient was scheduled to undergo an elective surgery with antihypertensive therapy. However, she presented with a chief complaint of abdominal pain and was diagnosed with intratumoral hemorrhage. Urgent TAE was performed that successfully achieved hemorrhage control. After TAE, serum levels of both epinephrine and norepinephrine were within the normal range. Abdominal computed tomography revealed resolving retroperitoneal hematoma. Elective open surgery was performed without significant intraoperative bleeding or fluctuations in blood pressure.

We report a case of successful preoperative TAE for functional PGL to control intraoperative blood pressure fluctuations and bleeding. Preoperative TAE could be a useful procedure for the surgical preparation of functional PGL, including unruptured cases.

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