Home > Case of the Month > Case 8

Case 8

History

  • 32yo female
  • ED admission: C/O: right flank pain, fever, N+V
  • O/E: renal angle tenderness
  • Urine dipstick: ++RBC, ++protein
  • IVU: NAD
  • CT: ?mass RK
  • Referred for MRI/MRA

  • Dx: Infarct of postero-medial aspect of lower pole of RK 2o renal arterial dissection
  • Aetiology: FMD
  • Fibromuscular dysplasia: female, young
  • Angiopathy of medium sized arteries
  • Renal arteries: 75%, Cerebrovascular (internal carotid>>vertebral): 25-30%, visceral: 9%, limbs: 5%, others
  • 26% >1 region
  • Clinical: Renal: HTN
  • Cerebrovascular: Stroke
  • DSA gold standard Dx

Findings

  • Beading (areas of relative stenoses or webs alternating with small fusiform or saccular aneurysms, media)
    • Smooth stenosis (intima, non-ostial)
    • Aneurysm **Dissection
  • Path: fibrodysplasia produces arterial stenosis
  • Effects different layers: intimal, medial (80-95%) or adventitial (rare)
  • ?Genetic ?Hormonal influence , Not inflammatory
  • Treatment: percutaneous angioplasty, avoid stenting
  • This patient was advised anticoagulation but refused!!