Selective arteriography as a localizing and provocative test in the diagnosis of pheochromocytoma.

Abstract

The diagnosis of pheochromocytoma is suspected in patients with paroxysmal or sustained hypertension associated with symptoms of headache, excessive perspiration, and palpitation (1). Many patients have nonspecific symptoms, however, and additional diagnostic evidence is sought from chemical, pharmacologic, or radiologic studies. Standard roentgen examinations, e.g., urography or laminagraphy, have not been sufficiently accurate for the diagnosis and localization of pheochromocytoma (2–4). The specialized radiographic technics such as retroperitoneal gas insufflation and arteriography may provide direct visualization of the tumor, but they carry a risk and have been associated with fatalities. Air embolism may be a complication of retroperitoneal gas insufflation. Death after aortography undertaken in patients with pheochromocytoma was reported by Saltz and his associates (6), and by Koonce, Pollock, and Glassy (7). In the two cases, the blood pressure was elevated after aortography, and vasomotor collaps...