Coronary Artery Supply to a Cardiac Mass.

BACKGROUND

Coronary artery perfusion of cardiac tumors is rare but carries diagnostic and therapeutic implications.

CASE SUMMARY: A 43-year-old incarcerated male with SDHD gene-associated hereditary paraganglioma-pheochromocytoma syndrome presented with dyspnea and leg edema. Computed tomography and cardiac magnetic resonance imaging revealed a vascular intrapericardial mass in the aortopulmonary window encasing major vessels. Left heart catheterization showed arterial supply from the left anterior descending and right coronary arteries. Given the vascular complexity of the pericardial mass, surgery was deferred. The patient was managed medically and was discharged with plans for I-131 metaiodobenzylguanidine and chemotherapy. Advanced imaging confirmed somatostatin-avid metastases.

DISCUSSION: This case demonstrates the value of multimodal imaging in evaluating coronary-perfused cardiac tumors. It also illustrates the systemic nature of diseases associated with SDHD gene pathology. Delayed follow-up during incarceration highlights a health equity concern, as incarcerated individuals often face barriers to specialty care.

TAKE-HOME MESSAGES: Cardiac tumors with coronary perfusion require advanced imaging. Addressing disparities in vulnerable populations is essential for equitable outcomes.