Presentation
Refractory hypertension despite maximal medical therapy.
Patient Data
Localized gross turbulence and increased peak systolic velocity to 600 cm/sec in the proximal right renal artery (with normal origin and more distal renal artery profiles).
Left renal artery has normal flow velocities.
CT angiography performed to confirm the duplex ultrasound findings
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Typical "beaded" appearance to the right renal artery as seen in fibromuscular dysplasia. Note that the right kidney is a little smaller than the left and that the left renal artery is normal as are other branches of the abdominal aorta.
Case Discussion
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease that causes abnormal growth within the vessel wall. It can involve the intima, media or adventitia.
The medial type is characterized by thickening of the media with collagen formation. It accounts for the vast majority of cases.
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