In Reply to: Case 0298_01 -- Hypertension in a 40-year-old woman posted by Editor on February 03, 1998 at 12:01:05:
Very unusual case with a wide variety of treatment options and treatment algorithms. I would resect the presumed pheo first and then treat the right side with embolization of the AVF and PTA/stent of the stenosis. I have never seen an AVF associated with FMD but I agree with Moni that it is possible that a small aneurysm secondary to the FMD may have ruptured and created the AVF presuming that the patient has not had a biopsy or other such intervention although the rate of aneurysm rupture in FMD is low. The appearance of this lesion is not the classic appearance associated with FMD and likey represents the perimedial or advential type of FMD. They may not respond as well to PTA due to significant elastic recoil and a stent may be needed.
One thing that I would consider is screening the patient for neurofibromatosis as there is a significant association of pheos with NF and NF can produce lesions in the renal artery mimicing FMD especially the advential type.
Great case and look forward to the follow up on this patient.