Fibromuscular Dysplasia Incidentally Identified with Computed Tomography Angiography
Henry Lee, BS, Bethany Lueck, MD, and Kevin M. Casey, MD, Santa Barbara, CA
A 78-year-old woman had presented to the emergency room with altered mental status after the inadvertent consumption of a cannabis product. A stroke workup was initiated, including computed tomography angiography, which demonstrated severe tortuosity and a beaded appearance of her bilateral internal carotid arteries (A/Cover and B). The radiographic imaging findings, including alternating areas of bulging and narrowing, were consistent with bromuscular dysplasia (FMD; C). The patient denied any history of transient ischemic attack, cerebrovascular accident, amaurosis fugax, or chronic kidney issues. The patient provided written informed consent for the report of her case details and imaging studies.
The etiology of FMD is not fully understood, with genetics, environmental factors, and
hormones recognized as potential etiologies.1 FMD is a noninflammatory, nonatherosclerotic disease that can be found in almost any artery in the body. However, the most common locations are the renal arteries, followed by the carotid and external iliac arteries. FMD can result in arterial stenosis, aneurysm, dissection, and/or occlusion; however, the large majority of patients will be asymptomatic.2 The prevalence is highest for women aged 20 to 60 years. Despite being considered a rare disease, FMD has been diagnosed more often largely due to increased patient imaging.
Patients with symptomatic FMD warrant intervention, although the constellation of symptoms can be unusual. Percutaneous transluminal angioplasty is the standard of care for patients who have experienced a cerebrovascular accident, transient ischemic attack, or amaurosis fugax. Stents should be reserved for patients in whom a dissection has occurred after angioplasty. Coil embolization should only be performed for patients with symptomatic aneurysms. Given that our patient was asymptomatic, 81 mg of aspirin daily was started, and she will continue to be monitored with serial ultrasound imaging every 6 to 12 months.
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