String of beads sign (vascular)

Last revised by Joshua Yap on 6 Oct 2022

The string of beads sign is the description typically given to the appearance of the renal arteries 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 of alternating disease-related stenoses with aneurysmal dilatation 1.

It was originally named after the appearance on digital subtraction angiography (DSA) but is equally well seen on contemporary CTA and MRA. It is also referred to as the "string of pearls sign" 2.

Fibromuscular dysplasia is one of the renovascular causes of secondary hypertension, whilst segmental arterial mediolysis is the most common cause of spontaneous intraperitoneal or mesenteric hemorrhage in the middle-aged and elderly.

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