Case report: Non-surgical triumph in pericardial paraganglioma: durable tumor regression via targeted embolization of coronary collaterals.

Background: Pericardial tumors are rare cardiovascular disorders that often present with non-specific clinical symptoms and have traditionally required surgical intervention. Multimodal imaging is crucial for diagnosis, treatment planning, and prognostic evaluation. Case presentation: A 60-year-old woman was referred to our institution with a one-year history of progressive exertional chest tightness and dyspnea, which had significantly worsened over the preceding month. Multimodal imaging diagnosed a pericardial tumor dependent on a circumflex artery fistula for its blood supply. Transcatheter embolization of the fistula was consequently performed to devascularize the tumor. At the 1-year follow-up, surveillance imaging demonstrated significant tumor regression. During follow-up, the patient reported substantial resolution of symptoms, and her blood pressure remained well-controlled. Conclusion: This case highlights the critical role of multimodal imaging in diagnosing and managing pericardial tumors. Furthermore, it demonstrates the therapeutic potential of transcatheter embolization for inoperable patients with pericardial paragangliomas.