A 32-year-old woman with resistant hypertension has an abdominal bruit. CT angiography shows bilateral renal artery stenoses with a string-of-beads appearance involving the middle and distal portions of the renal arteries. The aorta appears normal. What is the most likely underlying pathology?

• A Takayasu arteritis
• B Fibromuscular dysplasia ✓
• C Atherosclerotic renal artery stenosis
• D Neurofibromatosis type 1

Explanation

The string-of-beads appearance from alternating stenoses and aneurysmal dilatations in the middle and distal renal artery of a young hypertensive woman is pathognomonic of medial fibromuscular dysplasia. Unlike atherosclerosis, which affects the ostium and proximal third of older patients, FMD spares the aorta and responds well to percutaneous angioplasty without stenting. Takayasu arteritis involves the aorta and its major branches with wall thickening, and neurofibromatosis rarely produces this angiographic pattern.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.