Neoadjuvant Combined Preoperative Embolization of a Highly Vascularized Paraganglioma Associated With SIADH

Abstract

Background

Device-based embolization is a well-established medical procedure for treating several pathological conditions, including cerebral and peripheral pseudoaneurysms, congenital defects, and active bleeding. Nonetheless, an intriguing and relatively underexplored application of coils and microparticles involves the preoperative reduction of blood supply to ectopic masses.

Case summary

A 58-year-old woman was admitted to our institution with nausea and confusion, with a suspected diagnosis of syndrome of inappropriate antidiuretic hormone secretion. A computed tomography scan revealed a large mediastinal mass receiving blood supply from both the bronchial and coronary arteries. The mass was successfully excised surgically, following the embolization of the major feeding vessels using a combination of coils and microspheres.

Discussion

An uncommon presentation of a paraganglioma characterized by both mass effect and endocrine activity required a "neoadjuvant" treatment to ensure safer surgical management.

Take-home message

The percutaneous reduction of blood supply to tumoral mass could represent an effective strategy to guarantee a radical excision without major complications.