Localized renal artery dissection
Presentation with headaches. Found to have severe hypertension requiring maximal medical treatment. Duplex ultrasound suggests high grade renal artery stenosis. CTA for confirmation.
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Ectatic right renal artery with a localized luminal "flap" ~ 2.5cm from the origin, consistent with dissection. Left renal artery is normal.
The right renal artery shows an underlying abnormality of ectasia and slight luminal irregularity.
Differential diagnosis is a collagen disorder (unlikely given that all other vessels are normal), vasculitis and fibromuscular dysplasia (although the vessel does not have the typical "beaded" appearance). In the absence of trauma, all three conditions could be associated with spontaneous dissection.