Unusual Form of Fibromuscular Dysplasia of the Renal Artery in a Young Man: A Case Report

Fibromuscular dysplasia (FMD) of the renal artery is a rare, idiopatic and asymptomatic disease. The suspicion and the radiological evidence is disrupted by the occurrence of renovascular arterial hypertension in the subject under 30 years of age and is resistant to antihypertensive treatments. According to the literature, the prevalence in the general population is between 30 to 50 years of life and quite common in women than in men. Fibruscular dysplasia most commonly affects the renal, carotid and vertebral arteries, but it can theoretically affect any artery. Its prevalence is estimated between 4 and 6 % in the renal arteries and between 0.3 and 3 % in the cervico-encephalic arteries. Radiologists play an important role in the diagnosis of fibrous dysplasia, and a good knowledge of the signs of fibroscopic dysplasia will certainly help to reduce the delay between the first symptoms and the diagnosis. In order to assess and demonstrate the interest or the place of Radiology in the FMD diagnostic management, we report a case of fibromuscular dysplasia in a 27-year-old patient followed for ather hypertension since 2016 and resulting uncontrolled with often modification of antihypertensive treatment coming to triple therapy. An angio-scanner demonstrated the diagnosis: characteristic image string-of-beads aspect corresponding to the dilated sections of the right renal artery and the wire between the beads with narrowed sections. The confirmation was made by the arteriography which had shown stenosis of appearance in rosary. Endoluminal revascularization with placement of two stents was performed as a definitive treatment. Follow-up was simple for a period of one year with normalization of blood pressure.