Celeste
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(1/6/03 12:31 pm)
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Evaluation of Renal Arteries - 1/2/03
Krinsky's Case Challenge: Case IX: Evaluation of Renal Arteries
from Medscape Radiology
Clinical Commentary
In this case, The MR angiogram demonstrated a "beaded" appearance of the renal arteries, which is diagnostic for fibromuscular dysplasia (FMD). FMD is the second most common cause of renal artery occlusive disease and accounts for a large percentage of reported cases of renovascular hypertension in young adults. This condition is seen more often in women than in men, and is most commonly identified in young adults. FMD involves medium-size arteries and may affect the renal, carotid, vertebral, and mesenteric circulation.
There are 3 subtypes of fibromuscular dysplasia: medial fibroplasia (60%-80% of cases), perimedial fibroplasia (10%-25% of cases), and intimal fibroplasia (5% of cases). The disease is usually bilateral, with areas of luminal narrowing that alternates with multiple dilated or aneurysmal segments, resulting in the "beaded" appearance demonstrated in the figure. The distal renal arteries are usually involved in cases of FMD. Complications include embolization of thrombus from aneurysmal segments, which may cause infarcts and spontaneous dissection. Renal artery angioplasty is usually the treatment of choice for cases of mild disease. Complex aneurysms may require embolization or surgical repair. Atherosclerosis almost always presents with an ostial renal artery stenosis. Takayasu's arteritis usually involves other vessels and often presents with long, tapered stenosis or occlusion. Renal artery involvement in cases of neurofibromatosis generally begins in childhood and manifests with proximal stenosis.
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