Transient Hypertensive Response to CO2 Aortography in a Patient with Pheochromocytoma


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.

Share and Cite:

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.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Seeger, J.M., Self, S., Harward, T.R., et al. (1993) Carbon Dioxide Gas as an Arterial Contrast Agent. Annals of Surgery, 217, 688-698.
[2] Hawkins, I.F. (1982) Carbon Dioxide Digital Subtraction Arteriography. American Journal of Roentgenology, 139, 19-24.
[3] Hawkins, I.F., Wilcox, C.S., Kerns, S.R., et al. (1994) CO2 Digital Angiography: A Safer Contrast Agent for Renal Vascular Imaging? American Journal of Kidney Diseases, 24, 685-694.
[4] Gold, R.E., Wisinger, B.M., Geraci, A.R. and Heinz, L.M. (1972) Hypertensive Crisis as a Result of Adrenal Venography in a Patient with Pheochromocytoma. Radiology, 102, 579-580.
[5] Christenson, R., Smith, C.W. and Burko, H. (1976) Arteriographic Manifestations of Pheochromocytoma. American Journal of Roentgenology, 126, 567-575.
[6] Hosseinnezhad, A.I., Black, R.M., Aeddula, N.R., Adhikari, D. and Trivedi, N. (2011) Glucagon-Induced Pheochromocytoma Crisis. Endocrine Practice, 17, e51-e54.
[7] Allison, D.J., Brown, M.J., Jones, D.H. and Timmis, J.B. (1983) Role of Venous Sampling in Locating a Phaeochromocytoma. British Medical Journal (Clinical Research Ed.), 286, 1122-1124.
[8] Davies, R.A., Patt, N.L. and Sole, M.J. (1979) Localization of Pheochromocytoma by Selective Venous Catheterization and Assay of Plasma Catecholamines. Canadian Medical Association Journal, 120, 539-542.
[9] Li, W., Yang, B., Che, J.P., Yan, Y., Liu, M., Li, Q.Y., Zhang, Y.Y. and Zheng, J.H. (2013) Diagnosis and Treatment of Extra-Adrenal Pheochromocytoma of Urinary Bladder: Case Report and Literature Review. International Journal of Clinical and Experimental Medicine, 6, 832-839.
[10] Mukherjee, J.L., Peppercorn, P.D., Reznek, R.H., et al. (1997) Pheochromocytoma: Effect of Nonionic Contrast Medium in CT on Circulating Catecholamine Levels. Radiology, 202, 227-231.
[11] Bessell-Browne, R. and O’Malley, M.E. (2007) CT of Pheochromocytoma and Paraganglioma: Risk of Adverse Events with i.v. Administration of Nonionic Contrast Material. American Journal of Roentgenology, 188, 970-974.
[12] Rossi, P., Young, I.S. and Panke, W.F. (1968) Techniques, Usefulness, and Hazards of Arteriography of Pheochromocytoma: Review of 99 Cases. The Journal of the American Medical Association, 205, 547-553.
[13] van der Hosrst-Schrivers, A.N., Kerstens, M.N. and Wolffenbuttel, B.H. (2006) Preoperative Pharmacologicalmanagement of Phaeochromocytoma. Netherlands Journal of Medicine, 64, 290-295.
[14] Prys-Roberts, J.R. and Farndon, J.R. (2002) Efficacy and Safety of Doxazosin for Perioperative Management of Patients with Pheochromocytoma. World Journal of Surgery, 26, 1037-1042.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.