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Findings: Ptotic right kidney and an elevated left kidney within the abdomen with the renal arteries causing significant overlap with the celiac artery and the superior mesenteric arteries. The ostia of the renal arteries are not well visualized. There is a beaded appearance of the mid left main renal artery. Mild to moderate irregularity near the origin of the right main renal artery is also demonstrated. Severe bilateral SFA disease is noted.

Diagnosis: Ptotic right kidney with evidence of fibromuscular dysplasia involving the left main renal artery.

Discussion: Fibromuscular dysplasia is usually a disease of women between the ages of 40 and 70. Symptoms most often secondary to ischemic events (56 percent) or due to cerebral aneurysms (22 percent). Etiology is unknown and may involve the intima, the media or the adventitia. The renal artery has alternating areas of narrowing and dilatation giving a "string of beads" appearance which is pathognomonic. This is usually seen in hypertensive patients, involving the middle and distal thirds of the renal artery. In two-thirds of patients, it is bilateral.

References:

1. Baum S. Abram's Angiography, Vascular and Interventional Radiology,
   4th Edition. Little Brown and Company, New York 1997;1(13):307-311.

2. Uflacker R, et al. Interventional Radiology. McGraw-Hill, Inc.,
   New York 1991; 6:402-409.