Answer for BIR CoW 01 Mar 2026
Fibromuscular dysplasia
Findings
USG Left renal artery doppler shows parvus tardus waveform CT There is a short segment stenosis involving the proximal left renal artery with associated hypoenhancing left kidney indicating hypoperfusion. DSA Short segment narrowing at proximal renal artery with post stenotic dilatation and prominent collaterals from pre stenotic segment supplying upper pole. String of bead appearance of the left renal artery. Diagnosis: A case of unilateral fibromuscular dysplasia affecting the left renal artery in a 24 yr old female causing 80 % non ostial renal artery stenosis . Management: Renal balloon angioplasty.
Discussion
Fibromuscular dysplasia is an idiopathic, segmentary, non-inflammatory and non-atherosclerotic disease that can affect all layers of both small- and medium-calibre arteries. In renal artery involvement, it causes renal artery stenosis leading to early-onset hypertension (most common clinical feature), renal (epigastric) bruits, or renal impairment. Angiographically, fibromuscular dysplasia is classified into two types: Multifocal: usually caused by medial disease Focal: usually caused by intimal disease Imaging features: DSA: Gold standard ,helps in visualization of small or peripheral lesions. Also measuring pressure gradients across focal stenosis and deploying interventional treatments. Multifocal: alternating dilation and constriction (string of beads). Focal: focal concentric or tubular stenosis. CTA and MRA : In addition to visualizing the arteries, it allows the assessment of end-organ ischemic damage (renal infarcts, ischemic stroke). Treatment: Asymptomatic cases are treated conservatively and observed. In the absence of contraindications, low-dose aspirin is generally recommended. In symptomatic renal artery fibromuscular dysplasia, in addition to antihypertensives , angioplasty is the procedure of choice, with high long-term patency rates.
REFERENCES:
1. John A. Kaufman, Michael J. Lee. Vascular and Interventional Radiology. (2004) ISBN: 0815143699 - Google Books 3. Plouin PF, Perdu J, La batide-alanore A et-al. Fibromuscular dysplasia. 2007;2 : 28. doi:10.1186/1750-1172-2-28 - Free text at pubmed - Pubmed citation
Findings
USG Left renal artery doppler shows parvus tardus waveform CT There is a short segment stenosis involving the proximal left renal artery with associated hypoenhancing left kidney indicating hypoperfusion. DSA Short segment narrowing at proximal renal artery with post stenotic dilatation and prominent collaterals from pre stenotic segment supplying upper pole. String of bead appearance of the left renal artery. Diagnosis: A case of unilateral fibromuscular dysplasia affecting the left renal artery in a 24 yr old female causing 80 % non ostial renal artery stenosis . Management: Renal balloon angioplasty.
Discussion
Fibromuscular dysplasia is an idiopathic, segmentary, non-inflammatory and non-atherosclerotic disease that can affect all layers of both small- and medium-calibre arteries. In renal artery involvement, it causes renal artery stenosis leading to early-onset hypertension (most common clinical feature), renal (epigastric) bruits, or renal impairment. Angiographically, fibromuscular dysplasia is classified into two types: Multifocal: usually caused by medial disease Focal: usually caused by intimal disease Imaging features: DSA: Gold standard ,helps in visualization of small or peripheral lesions. Also measuring pressure gradients across focal stenosis and deploying interventional treatments. Multifocal: alternating dilation and constriction (string of beads). Focal: focal concentric or tubular stenosis. CTA and MRA : In addition to visualizing the arteries, it allows the assessment of end-organ ischemic damage (renal infarcts, ischemic stroke). Treatment: Asymptomatic cases are treated conservatively and observed. In the absence of contraindications, low-dose aspirin is generally recommended. In symptomatic renal artery fibromuscular dysplasia, in addition to antihypertensives , angioplasty is the procedure of choice, with high long-term patency rates.
REFERENCES:
1. John A. Kaufman, Michael J. Lee. Vascular and Interventional Radiology. (2004) ISBN: 0815143699 - Google Books 3. Plouin PF, Perdu J, La batide-alanore A et-al. Fibromuscular dysplasia. 2007;2 : 28. doi:10.1186/1750-1172-2-28 - Free text at pubmed - Pubmed citation
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!