String of beads sign (renal artery)

Dr Dan J Bell and Dr Ian Bickle et al.

The string of beads sign is the description typically given to the appearance of the renal artery in fibromuscular dysplasia (FMD) but may also be used to describe the appearance of splanchnic arteries in segmental arterial mediolysis (SAM). It refers to the appearance arising from the stenoses resulting from the disease alternating with aneurysmal dilatation 1.

It was originally described from its appearances on digital angiography, but is equally well seen on contemporary CTA and MRA. It is also referred to as the string of pearls 2. FMD is one of the renovascular causes of secondary hypertension, while SAM is the most common cause of spontaneous intraperitoneal or mesenteric haemorrhage in the middle-aged and elderly. 

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Article information

rID: 21267
Section: Signs
Synonyms or Alternate Spellings:
  • String of pearls sign - renal artery
  • String of beads sign - renal artery

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Cases and figures

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    CE-MRA thin-slab MIP
    Case 1: FMD
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    Case 2: SAM
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    Case 3: FMD
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