case_images: PMC8207260_01
case_images: 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.
case_images: 10.1177_2050313X211025922-fig1.jpg
case_images: PMC8207260_01_10.1177_2050313X211025922-fig1.jpg
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case_images: 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).
case_images: 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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case_images: PMC8207260_01_10.1177_2050313X211025922-fig2.jpg
case_images: fig2-2050313X211025922
case_images: 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).
case_images: 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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case_images: 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.
case_images: 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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case_images: PMC8207260_01_10.1177_2050313X211025922-fig4.jpg
case_images: fig4-2050313X211025922
case_images: 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.
case_images: 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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case_images: 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).
case_images: 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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case_images: 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).
case_images: OCT of the right renal artery with demonstratable narrowing of the lumen.
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case_images: 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).