New onset hypertension-rare intimal variant fibromuscular dysplasia

Fibromuscular dysplasia (FMD) involving the renal arteries commonly presents as hypertension secondary to renal artery stenosis. Atypical patterns involving intima are rare and contribute to less than 10% cases of FMD. We present a relatively uncommon case of new onset hypertension in a 30-year-old woman resulting from intimal variant FMD involving the left renal artery. Renal duplex ultrasonography and angiography showed stenosis of the left renal artery consistent with intimal variant FMD. Percutaneous transluminal angioplasty of the stenotic lesion was successfully performed. Following angioplasty, her blood pressure was normalized. Renovascular hypertension secondary to FMD involving intimal layer is rare and requires a high index of clinical suspicion. Renal duplex ultrasonography is the recommended initial test of screening for renal artery stenosis in appropriate patients. The standard selective renal angiography, intravascular ultrasound, along with or without hemodynamic assessment should be utilized when renovascular intervention is contemplated. Percutaneous transluminal angioplasty is the mainstay of treatment for those who meet the criteria of intervention.