Bronchoscopic management of an endobronchial primary paraganglioma

Primary pulmonary paraganglioma is an extremely rare entity. Less than 20 cases have been reported in the English literature and little is known about the natural history, optimal management, and ultimate prognosis of this disease. Paragangliomas are thought to arise from neuroendocrine chemoreceptors and are most commonly discovered in the head and neck and retroperitoneal regions. Anecdotal case reports in the literature include presentations that vary from asymptomatic, incidental solitary nodules to metastatic, catecholamine-producing lesions. Pulmonary paragangliomas are often located in the intraparenchymal or subpleural spaces. There is little literature regarding the local management of endobronchial paragangliomas. We report a case of a 54-year-old woman presenting with a history of shortness of breath, hemoptysis, and chest pain who was found to have a large endobronchial paraganglioma completely obstructing her distal trachea and left mainstem bronchus. She underwent Nd:YAG laser photo-therapy with subsequent stent placement. These interventional bronchoscopic techniques successfully relieved her obstruction and allowed rapid weaning from mechanical ventilation.