TITLE:
Transient Hypertensive Response to CO2 Aortography in a Patient with Pheochromocytoma
AUTHORS:
Nimesh Patel, Kyung J. Cho
KEYWORDS:
CO2, Aortography, Paraganglioma, Caval Venous Sampling, Renal Artery Stenosis
JOURNAL NAME:
Open Journal of Radiology,
Vol.5 No.1,
February
26,
2015
ABSTRACT: We report
on a 15-year-old male with 4-year history of hypertension and retroperitoneal masses
referred to Interventional Radiology to evaluate the nature of the persistent masses
and renal artery stenosis. Angiographic evaluation began with CO2aortogram
during which the patient had a hypertensive response with bradycardia and arrhythmia
to the intra-aortic injection of CO2. His hypertension, bradycardia,
and arrhythmia responded to an intravenous nitroglycerin drip without administration
of alpha or beta blockers. Due to this response and neovascularity of the mass,
selective venous sampling of catecholamines and renin was performed which confirmed
functioning paragangliomas and hemodynamically significant stenosis of left accessory
renal artery, respectively. This is the first known case of hypertensive response
to CO2 aortography in a patient with unsuspected functioning paragangliomas.
We propose that patients with known or suspected diagnosis of catecholamine-secreting
tumors undergoing CO2 angiography should be considered for pre-procedural
treatment with alpha and beta blockage or have the appropriate medication on hand
with close monitoring in the event of hypertensive response.