Portal de Periódicos da CAPES

Angiographic Localization of Pheochromocytoma

1966; Radiological Society of North America; Volume: 86; Issue: 2 Linguagem: Inglês

10.1148/86.2.266

1527-1315

Plinio Rossi, Leonard Kaufman, Francis F. Ruzicka, William F. Panke,

Pituitary Gland Disorders and Treatments

In the study of hypertension, renal vascular lesions were the only indication for angiography until recently, when clear radiographic demonstrations of pheochromocytoma were obtained following the injection of contrast medium into the aorta, or after selective renal artery catheterization (1, 3, 7, 8, 10, 12, 16, 19, 21, 22a). In the past, hypertensive patients in whom pheochromocytoma was suspected were examined by conventional radiographic technics only, mainly intravenous pyelography and retroperitoneal pneumography (20–24). Although pheochromocytomas may arise in the chromaffin tissue anywhere in the body (9, 17, 18), the overwhelming majority arise in the adrenal glands. Our main concern in arteriography for their diagnosis, then, is the visualization of the vessels leading to these glands. Usually three arteries supply the suprarenal gland (13): the superior, the middle, and the inferior suprarenal. The superior suprarenal artery arises from the inferior diaphragmatic artery, the middle directly from the aorta at the level of the superior mesenteric artery, and the inferior from the renal artery. The great variation in number and origin of the suprarenal arteries, however, and their small caliber and the superimposition of other arteries in aortography make their complete identification difficult. The inferior suprarenal artery, by virtue of its origin from the renal artery, can be clearly visualized by selective renal catheterization. Therefore, we believe that this procedure, in addition to the preliminary aortogram, is a sine qua non in the definitive demonstration of pheochromocytoma. Technic of Examination With use of the Seldinger technic, a straight yellow or grey Kifa catheter with multiple side-holes is advanced from the femoral artery into the abdominal aorta to the level of the first lumbar body. By means of an automatic injector, 50 cc of either 75 per cent Hypaque or 76 per cent Renografin is injected in one-and-a-half to two seconds. A total of 10 films is obtained with the Schönander changer at the rate of 4 films per second for two seconds, followed after two seconds (for demonstration of the capillary and venous phases) by 2 additional films. The radiographs are examined immediately while the patient remains on the table. If no disorder is demonstrated upon a thorough and careful study of the different phases of the aortogram, the examination is considered complete. If, however, there is a suspicion of disease because of questionable staining in the region of the adrenal glands or slight hypertrophy of one of the suprarenal arteries, direct catheterization of the renal artery with a curved catheter is carried out. If possible, the catheter is passed into one of the suprarenal arteries. This procedure permits better demonstration of abnormal vascular patterns within the tumor.