PMC8207260_01
Renal duplex ultrasound of the right kidney. Peak systolic velocity notable for 501.3 cm/s with an end-diastolic velocity of 245.9 cm/s.
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Given concern for an underlying secondary cause of his hypertensive urgency, a renal duplex ultrasound was performed and demonstrated severely increased velocities (Figures 1 and 2) in the right mid-to-distal renal artery (highest peak-systolic velocity 501 cm/s, end-diastolic velocity 246 cm/s, renal/aortic ratio 7.6).
Renal duplex ultrasound of bilateral kidneys. Appreciable blunting of wave forms in the right kidney (Panel a) in comparison to the left kidney (Panel b).
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Given concern for an underlying secondary cause of his hypertensive urgency, a renal duplex ultrasound was performed and demonstrated severely increased velocities (Figures 1 and 2) in the right mid-to-distal renal artery (highest peak-systolic velocity 501 cm/s, end-diastolic velocity 246 cm/s, renal/aortic ratio 7.6).
CT angiogram of the abdomen/pelvis revealed significant beading of the mid right renal artery (solid white arrow), as well as ectasia of the right iliac and hepatic arteries (unfilled arrows).
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A CTA of the abdomen and pelvis (Figures 3 and 4) demonstrated beading of the mid segment of the right renal artery with mild atrophy of the right kidney, suggestive of FMD.
CT angiogram of the abdomen/pelvis with demonstration of the classic "beads on a string" appearance of the mid right renal artery.
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A CTA of the abdomen and pelvis (Figures 3 and 4) demonstrated beading of the mid segment of the right renal artery with mild atrophy of the right kidney, suggestive of FMD.
Right renal artery angiography (a) before and (b) after serial balloon dilations. Image (a) demonstrates the significant narrowing of the mid-artery.
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Angiography demonstrated multifocal FMD of the right renal artery with severe stenosis confirmed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT; Figures 5 and 6). Serial balloon dilations were performed using 3.0 and 4.0 mm balloons with good angiographic result and no dissection or perforation (Figure 5).
Lumen profile of the right renal artery with optical coherence technology (OCT). Demonstration of multiple sequential sections of luminal narrowing consistent with FMD.
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Angiography demonstrated multifocal FMD of the right renal artery with severe stenosis confirmed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT; Figures 5 and 6). Prior to angioplasty, OCT of the right renal artery revealed circumferential fibrotic tissue at the stenotic lesions, consistent with FMD pathology (Figures 6 and 7).
OCT of the right renal artery with demonstratable narrowing of the lumen.
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Prior to angioplasty, OCT of the right renal artery revealed circumferential fibrotic tissue at the stenotic lesions, consistent with FMD pathology (Figures 6 and 7).