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A 36 year old woman with a history of a gradual increase in blood pressure presented at our hospital. A renogram was performed and a decreased blood flow in the first and second phases was observed in the right kidney, with a significantly higher activity of serum renin in the right renal vein compared with the left. Furthermore, a bruit could be heard at the right lateroabdominal site, so right sided renovascular hypertension was suspected.
To evaluate the renal arteries, enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric, Milwaukee, Wisconsin, USA) was performed with a 1.25 mm slice thickness, helical pitch 7. Following intravenous injection of 100 ml of iodinated contrast material (350 mgI/ml), CT scanning was performed and volume data were transferred to a workstation (M900, Zio, Tokyo, Japan). The curved planar reconstruction image indicated a moniliform irregularity in the mid portion of the right renal arterial lumen (arrowhead in the upper right hand panel), suggesting renovascular hypertension caused by fibromuscular dysplasia.
Selective renal arteriography was therefore performed revealing the moniliform lumen of the mid portion of the right renal artery in the same position as the CT image (arrowhead in panel A). Intravascular ultrasound revealed four segmental luminal stenotic sites, approximately 2 mm in diameter, with an echolucent area just outside the intima (arrowhead in panel B), suggesting a thickening of smooth muscle cells. These thickenings were spotty, located among an average 4.5 mm diameter’s normal lumina (panel C), the typical configuration of fibromuscular dysplasia in renovascular hypertension. Percutaneous transluminal angioplasty was therefore performed with good results.