A 14 year old boy was admitted in Apollo Children’s Hospital, Chennai with severe Hypertension and a tumor in the chest. He was evaluated by Endocrinologist, Dr.S.Ramkumar. Investigations showed very high level of adrenaline in blood and a MIBG Scan confirmed the chest tumor and Hypertension due to a rare tumor called Paraganglioma.
The child was planned for Video Assisted Thoracoscopic Surgery (VATS) by Thoracic Surgeon, Dr.Rajiv Santosham. Tumors like Paraganglioma and Pheochromocytoma secrete excess catecholamines like adrenaline in the blood and cause uncontrolled swings in blood pressure during surgery. So his blood pressure was optimally controlled with medicines prior to surgery. After complete control of blood pressure, Dr. Rajiv Santosham successfully performed VATS to remove the tumor. Intra-operative course was managed by Anaesthetists, Dr. Sanjay Prabhu and Dr. Anuradha.
Paraganglioma and Pheochromocytoma are rare catecholamine adrenaline secreting tumors. While Pheochromocytoma occurs in the adrenal glands, Paragangliomas are extra-adrenal and occurs in the abdomen, head, neck and chest. Paragangliomas secrete adrenaline in an uncontrolled fashion and cause serious health problems including stroke, heart attack, and even death. In the child’s case, Paraganglioma was identified in his chest in mediastinum. This is the first time VATS has been reported to remove mediastinal paraganglioma in a child in India. After VATS, his blood pesssure normalised without anti-hypertensive drugs and he was discharged without any medicines.
VATS- Video Assisted Thoracoscopic Surgery is a Minimally Invasive surgical technique in the chest. During VATS, a tiny camera (Thoracoscope) and surgical instruments are inserted into the chest through small incisions. The thoracoscope transmits images of the inside of the chest onto a video monitor, guiding the surgeon in performing the procedure. The traditional surgery done for these tumors was by open surgery called thoracotomy.When compared to thoracotomy, VATS result in less pain and shorten recovery time.
CT and MIBG images of the tumor