增强CT上的节段性低密度区是诊断支动脉纤维肌肉发育不良的可能线索。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Yuko Kiyohara, Rei Hirose, Hiroshi Kawamata, Kazuki Nakai, Akane Hirataka, Jun Saito, Yuya Tsurutani
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引用次数: 0

摘要

摘要:纤维肌肉发育不良可引起肾血管性高血压。由于纤维肌肉发育不良可能未被充分诊断,因此精确的诊断和治疗至关重要,特别是对年轻女性。一位20岁的女性高血压和低钾血症被转介到我们医院进一步评估继发性高血压。在原医院,她的血压为160/110 mmHg,血清钾水平为2.9 mEq/L。对比增强计算机断层扫描的平衡期显示右肾中上部有一个低密度区。入院时,患者在5 mg氨氯地平治疗下血压为141/96 mmHg。实验室检测显示血浆肾素活性11.3 ng/mL/h,血浆醛固酮浓度117.1 pg/mL。肾静脉活性肾素浓度采样显示右肾素与左肾素之比为3.13,证实右肾肾素分泌明显增加。选择性肾血管造影发现局灶性狭窄伴右侧肾动脉近支邻近动脉瘤扩张和扭曲。她被诊断为分支动脉纤维肌肉发育不良,并通过经皮腔内血管成形术成功治疗。经治疗,患者无高血压、低血钾症状,无需任何药物治疗。由于支动脉纤维肌肉发育不良有时难以诊断,对比增强计算机断层扫描是一种很有前途的诊断工具,正如本病例所示。在治疗方面,我们的患者接受了经皮腔内血管成形术治疗,这对于育龄妇女来说是应该考虑的,因为推荐的抗高血压药物即使在怀孕的前三个月也可能是致畸的。学习要点:虽然分支动脉纤维肌肉发育不良(FMD)有时难以诊断,但在高肾素、高醛固酮高血压患者中应予以考虑。支动脉FMD在增强ct上表现为肾低密度区,如图所示。经皮腔内血管成形术(PTA)是分支动脉FMD的合适治疗方法,尤其是年轻女性患者。PTA可立即改善高血压和低钾血症,无需药物治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Segmental low-density area on contrast-enhanced CT is a possible clue to diagnosing branch artery fibromuscular dysplasia.

Summary: Fibromuscular dysplasia can cause renovascular hypertension. Since fibromuscular dysplasia may be underdiagnosed, precise diagnosis and management are crucial, especially for young women. A 20-year-old woman with hypertension and hypokalemia was referred to our hospital for further evaluation of secondary hypertension. At the previous hospital, her blood pressure was 160/110 mmHg and the serum potassium level was 2.9 mEq/L. The equilibrium phase on contrast-enhanced computed tomography revealed a low-density area in the upper median portion of the right kidney. On admission to our hospital, her blood pressure was 141/96 mmHg under 5 mg of amlodipine. Laboratory tests revealed plasma renin activity of 11.3 ng/mL/h and plasma aldosterone concentration of 117.1 pg/mL. Renal venous sampling of active renin concentration showed a right-to-left renin ratio of 3.13, confirming a significant increase in renin secretion from the right kidney. Selective reno-angiography detected focal stenosis with adjacent aneurysmal dilation and tortuosity in the proximal branch of the right renal artery. She was diagnosed with branch artery fibromuscular dysplasia and successfully treated with percutaneous transluminal angioplasty. After the treatment, she was free from hypertension and hypokalemia without any medications. Since branch artery fibromuscular dysplasia is sometimes difficult to diagnose, contrast-enhanced computed tomography can be a promising diagnostic tool as shown in this case. Concerning treatment, our patient was treated with percutaneous transluminal angioplasty, which should be considered for women of reproductive age because recommended antihypertensive medications can be teratogenic even in the first trimester of pregnancy.

Learning points: Although branch artery fibromuscular dysplasia (FMD) is sometimes difficult to diagnose, it should be considered in patients with high-renin, high-aldosterone hypertension. Branch artery FMD can present with a low-density area of the kidney on contrast-enhanced computed tomography, as shown in this case. Percutaneous transluminal angioplasty (PTA) can be an appropriate treatment for branch artery FMD, especially in young female patients. PTA may immediately improve hypertension and hypokalemia without the need for medications.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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