Mediastinal paraganglioma is a rare and slow growing neurogenic tumor. Here, we describe a 49-year-old woman with a non-functional posterior mediastinal paraganglioma. Video-assisted thoracoscopic surgery for tumor excision failed due to massive bleeding. The tumor was excised successfully by lateral thoracotomy with bipolar electrocautery 1 week after the first operation. Mediastinal paraganglioma remains a surgical challenge due to its hypervascular character and firm adhesion to adjacent mediastinal structure. Since the non-functional posterior mediastinal paraganglioma is often diagnosed after operation, it should be regarded as a differential diagnosis of mediastinal mass, especially if surgeons experience unexpected massive bleeding during operation.