VATS Resection of a Posterior Mediastinal Tumor of the Superior Sulcus

This video illustrates a procedure for a patient who was initially diagnosed with a duplication cyst on computed tomography scan but was found to have a posterior mediastinal tumor in the superior sulcus during a video-assisted thoracoscopic procedure.

Paragangliomas are neuroendocrine tumors originating from chromaffin cells located in extra-adrenal sympathetic ganglia. They are also called extra-adrenal pheochromocytomas, and they can be classified as functional or nonfunctional according to their ability to produce and release catecholamines. Most paragangliomas are found incidentally or secondary to compressive symptoms. Functional paragangliomas are extremely rare but do account for some cases that present with persistent hypertension.

Paragangliomas can occur in the abdomen (80-95%), chest (10%), pelvis or head and neck (5%), and mediastinum (1-2%). When they occur in the mediastinum, they are usually found in the posterior mediastinum along the sympathetic plexus.

Suggested Reading

1. Soffer D, Scheithauer BW. Paraganglioma. In: Kleihues P, Cavenee WK, eds. Pathology and genetics of tumours of the nervous system. 2nd ed. Lyon, France: IARC Press; 2000:112-114.
2. Suzawa K, Yamamoto H, Ichimura K, Toyooka S, Miyoshi S. Asymptomatic but functional paraganglioma of the posterior mediastinum. Ann Thorac Surg. 2014;97(3):1077-1080.
3. Wald O, Shapira OM, Murar A, Izhar U. Paraganglioma of the mediastinum: challenges in diagnosis and surgical management. J Cardiothorac Surg. 2010;5:19.