PMC10291322_01
Computed tomography angiogram showing right renal infarction (right panel), left internal iliac artery aneurysm (left panel), and right internal mammary artery aneurysm (bottom panel).
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F1
A computerized tomography angiography scan of the abdomen demonstrated a right renal infarct (Figure 1) and was started on intravenous heparin. The patient was also noted to have a 5.5 cm x 5.1 cm left internal iliac artery aneurysm with no aneurysmal leakage or dissection, and a vascular surgeon was consulted (Figure 1). The right renal artery showed a dissection, 3 cm distal to the origin from the aorta with a focal sub-1 cm intimal defect noted just proximal to the first bifurcation of the right renal artery (Figure 1). The dissection of the right renal artery focally compressed the true lumen of the right renal artery with a thrombosis of the false lumen (Figure 1).
Left upper panel: right renal artery dissection with intimal defect (white arrow) and dissection distal to bifurcation (white triangles). Right upper panel: longitudinal section of a bifurcated right renal artery with false lumen (green arrows) and true lumen (blue arrows). Left lower panel: right renal artery dissection. (T = true lumen, F = false lumen with thrombus) H&E stain 4x. Right lower panel: (T = true lumen, F = false lumen with thrombus) VVG stain 4x.
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F2
Organizing thrombus was present in the false lumen of the right renal artery dissection (Figure 2).
Pedigree with negative first-degree genetic testing results.
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F3
Genomics Clinic. Genetic testing did not identify the same variant or other pathogenic variants in FBN1 in any of the parents and siblings (Figure 3).