Case 55
Clinical Presentation
A 56-year-old man with uncontrollable hypertension.
Imaging Findings
Oblique maximum intensity projection image of a contrast-enhanced magnetic resonance angiogram shows the outline of the aorta to be irregular (arrow). There is discontinuity indicating severe focal narrowing (arrowhead) of the right renal artery ~1 cm from its origin. Enhancement of the kidneys is normal.
Differential Diagnosis
• Atherosclerotic renal artery stenosis (RAS): The presence of atherosclerotic disease elsewhere is characteristic. Typically, the location of a stenosis due to atherosclerosis is at the origin of the renal artery. A location close to the middle of the vessel, as in this case, is less typical but can happen.
• RAS due to fibromuscular hyperplasia: Although rare, fibromuscular hyperplasia is the second most common cause of RAS. The stenosis is usually central, usually not at the origin, and beading of the renal arteries is expected.
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