Transient Hypertensive Response to CO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; Aortography in a Patient with Pheochromocytoma

Nimesh Patel,Kyung J Cho

doi:10.4236/ojrad.2015.51001

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.

Highlights

CO2 has been increasingly used as a contrast agent since the advent of digital subtraction angiography has
Since the advent of digital subtraction angiography, CO2 has commonly been used as a safe alternative contrast agent for diagnostic angiography and endovascular procedures in patients with or without renal failure and contrast allergies
To the best of our knowledge, this is the first case of a hypertensive response to the intra-aortic injection of CO2 for aortography in a patient with catecholamine-secreting paraganglioma

Summary

Introduction

How to cite this paper: Patel, N. and Cho, K.J. (2015) Transient Hypertensive Response to CO2 Aortography in a Patient with Pheochromocytoma. A pheochromocytoma may cause a hypertensive crisis It is usually benign but can be malignant in 10% of cases. Hypertensive crisis induced by intra-arterial injection of ionic contrast medium in patients with catecholamine-secreting tumors is a well-known phenomenon [4] [5]. Certain agents, such as glucagon, have been reported to induce catecholamine release from pheochromocytomas with subsequent multi-organ injury [6]. We are reporting the first case of CO2 angiography resulting in a hypertensive response with bradycardia and arrhythmia in a patient with catecholamine-secreting tumor

Case Summary

Discussion

Conclusion