E1675. Multimodality Imaging of Thoracic and Abdominal Causes of Secondary Hypertension
  1. Mohammed Siddiqui; University of Missouri
  2. Sara Sartaj; SSM Health St. Mary's Hospital
  3. Lauren Arnold; University of Missouri
  4. Cody Lee Thornburgh; University of Missouri
  5. Nanda Thimmappa; University of Missouri
  6. Ayman Gaballah; University of Missouri
Imaging plays a minor role in evaluation of primary hypertension, but is an integral part of clinical decision-making in secondary hypertension, which is defined as high blood pressure that is caused by known medical condition. There are many causes of secondary hypertension in the chest and abdomen, and an accurate diagnosis provides an opportunity to achieve the best outcome with specific targeted medical therapy, and in some cases even achieve surgical cure.

Educational Goals / Teaching Points
Assess the epidemiology, classification, and etiopathogenesis of the secondary hypertension. Review the role of imaging in localizing the pathology in the chest and abdomen. Highlight the impact of imaging findings on management options.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A. Renal disease: 1. Renal parenchymal causes a. Diabetic nephropathy b. Glomerular disease c. Polycystic kidney disease d. Page kidney 2. Renovascular hypertension a. Atherosclerosis b. Fibromuscular dysplasia B. Adrenal disease: 1. Hyperaldosteronism (Conn Syndrome) 2. Hypercortisolism (Cushing syndrome) 3. Phaeochromocytoma C. Paranganglioma D. Ectopic ACTH secretion (Cushing syndrome) 1. Small cell lung cancer 2. Small cell cancers of the thymus 3. Bronchial carcinoid 4. Pancreatic neuroendocrine tumor 5. Ovarian tumor E. Cardiovascular HTN 1. Coarctation of aorta F. Miscellaneous causes 1. Syndromes a. Von-Hippel Lindau b. Neurofibromatosis c. Multiple endocrine neoplasia 2. Ectopic hyperparathyroidism 3. Vasculitides 4. Pregnancy related causes 5. Drug and toxic agents related causes

Secondary hypertension accounts for approximately 5-10% of the cases of hypertension. Imaging plays an important role for localizing the causes of secondary hypertension in chest and abdomen, which in some cases may result in complete surgical cure, obviating the need for lifelong antihypertensive treatment.