OJRad  Vol.5 No.1 , March 2015
Transient Hypertensive Response to CO2 Aortography in a Patient with Pheochromocytoma
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.
Cite this paper: Patel, N. and Cho, K. (2015) Transient Hypertensive Response to CO2 Aortography in a Patient with Pheochromocytoma. Open Journal of Radiology, 5, 1-7. doi: 10.4236/ojrad.2015.51001.

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