Roentgen diagnosis of fibromuscular hyperplasia of the renal arteries.

Abstract

Fibromuscular hyperplasia of the renal artery has recently been reported as a cause of renal arterial stenosis and secondary hypertension in a small number of cases. Leadbetter and Burkland (2) first described the entity in a five-and-one-half-year-old Negro boy. DeCamp and Birchall (1) reported a case in a twenty-three-year-old male. McCormack et al. (3) added 3 examples but did not mention the sex of their patients. Poutasse and Dustan (5) described “fibrous intimal proliferation” in the renal artery of 2 young persons with hypertension but they, also, failed to designate the sex. Wylie and Wellington (6) pointed out characteristic features of fibromuscular hyperplasia of the renal artery in 3 patients and made reference to an additional 5 cases. The following report emphasizes the roentgen findings in 11 patients with fibromuscular hyperplasia of the renal arteries seen within a period of two years, including the cases described by Wylie and Wellington. Ten were investigated at the University of California Medical Center and 1 at the Veterans Administration Hospital, San Francisco, Calif. The patients were all females between fifteen and forty-nine years of age, with hypertension known to have been present one week to twelve years. The blood pressure elevation was mild in 1 case and moderate to severe in the remainder, with a preoperative range of 170/100 to 250/140. In 3 patients the hypertension was asymptomatic. All but 1 had an audible systolic bruit in the upper abdomen. To date 9 of the patients have been explored surgically. In each, the stenotic lesion in the renal artery or arteries was found to be due to hypertrophy of the muscular elements and, to a lesser extent, to the fibrous connective-tissue elements of the media of the vessels. Arterial reconstructive procedures were performed in all cases with the exception of 1 in which nephrectomy was done. Following operation, blood pressure returned to normal levels in 5 and decreased significantly, but not to normotensive levels, in 3 patients. Hypertension returned in 1 instance after an initial postoperative decrease in blood pressures; renal arteriography demonstrated development of further arterial stenosis. Roentgen Features Location: Unlike arteriosclerotic narrowings of the renal arteries, which tend to occur predominantly within the medial third of the vessel, fibromuscular hyperplasia appears to involve primarily the middle and/or distal third and may extend into the proximal branches of the main renal artery. In the present series the right renal artery alone was involved in 7 patients, both arteries in 3, and the left artery in 1. Appearance: In each instance the area of involvement presented a distinctive appearance on renal arteriography. The most common configuration is best described as a contrast-outlined image resembling a string of beads of varying size (Fig. 1, A and B).