|Patient: 4 year old male|
|History: 5-year-old boy with known diagnosis of fibromuscular dysplasia, who has vessel disease to his kidneys as well as occasional headaches and abdominal pain.|
CEREBRAL ANGIOGRAM - 06/11/2001:
FINDINGS: There are two foci of high-grade, web-like stenosis in the right internal carotid artery. These stenoses are approximately 2 cm apart. The most proximal stenosis is approximately 2 cm from the origin of the bifurcation. The internal maxillary artery from the right external carotid artery injection demonstrates a beaded appearance suggestive of fibromuscular dysplasia. Some irregularity of the superior thyroidal artery on this right side could represent narrowing, however, spasm cannot definitely be excluded. Multiple collaterals from the external carotid artery on the right side to the internal carotid artery circulation is demonstrated including middle meningeal, meningo-hypophyseal and orbital branches. There is mild irregularity of the cavernous and supraclinoid right internal carotid artery. The right middle cerebral artery and both anterior cerebral arteries fill from this right common carotid artery injection. Exuberant collaterals are present from the right external carotid artery circulation filling the right internal carotid artery circulation. From the left external carotid artery injection, there is no significant collateral supply to the internal carotid artery territory. The previously noted collateral supply to the vertebral territory from the occipital artery is not well demonstrated on today's exam due to the more distal position of the catheter on today's study. The left internal carotid artery demonstrates occlusion at the proximal cavernous segment with reconstitution more distally via meningo-hypophyseal branches.
The left vertebral artery is large and tortuous. The portion in the neck is not demonstrated, but is large under fluoro evaluation. Intracranially, there are patent bilateral posterior communicating arteries filling both anterior and both middle cerebral arteries.
CEREBRAL ANGIOPLASTY - 06/13/2001:
CLINICAL HISTORY: 4-year-old male with 2 and possibly 3 focal high grade stenoses in the right internal carotid artery which were seen on the cerebral angiogram performed on 6/11/01.
FINDINGS: Three focal high-grade (greater than 95%) stenoses are seen in the cervical portion of the right internal carotid artery. These findings are consistent with the patient's history of fibromuscular dysplasia. The right common carotid artery and external carotid artery are widely patent. The right internal maxillary artery is mildly diffusely diseased. Normal filling of the venous structures is seen on the delayed images.
Following angioplasty of the right internal carotid stenoses, the vessel is widely patent. Mild irregularity in the vessel contour is seen with no focal areas of stenosis.
No intravascular flaps or evidence of dissection are seen post angioplasty.
IMPRESSION: Angioplasty of 3 focal high-grade stenoses in the right internal carotid artery with no residual stenosis post angioplasty.
1. Complete occlusion of the distal left internal carotid artery at the proximal cavernous segment. Distally, there is reconstitution via meningo-hypophyseal branches.
2. High-grade foci of stenosis nearly web-like in the right internal carotid artery consistent with fibromuscular dysplasia.
3. Exuberant collaterals from right external carotid artery to the right internal carotid artery including middle meningeal, meningohypophyseal, and orbital branches.
4. Stenosis in the right internal carotid artery, as well as a beaded appearance of the right internal maxillary artery, suggests fibromuscular dysplasia.
5. Large left vertebral artery with patent bilateral posterior communicating arteries filling the left and right anterior and middle cerebral arteries.
No comments posted.
Case Number: 7221475Last Updated: 2011-04-23 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.