Fibromuscular Dysplasia Miranda Forrest Baker College
Overview Case Study Patient Information Exam Images Findings FMD Types Signs and Symptoms Treatment
Case Study Patient Information Female 57 years old Symptoms: Chronic Headaches Testing Performed: Bilateral Carotid Duplex
Carotid Duplex Sagittal view of the Right ICA
Carotid Duplex Color Doppler of Right ICA
Carotid Duplex Normal Waveform of Proximal Right ICA
Carotid Duplex Abnormal Waveforms in Mid and Distal ICA
Carotid Duplex Sagittal Images of the Left ICA
Carotid Duplex Normal Waveforms in the Left ICA
Carotid Duplex Elevated Velocities in Left Distal ICA
Findings The patient was diagnosed with bilateral fibromuscular dysplasia (FMD). A CT angiography was performed and confirmed the ultrasound findings. No other vessels were found to be affected. The patient will be followed on a yearly basis.
FMD What is it? Abnormal cell growth inside the walls of an artery Can affect arteries in many places, but most commonly in the carotid arteries and the renal arteries Causes areas of narrowing in the vessel Aneurysm and dissection in the affected vessel often occur
FMD- Who does this disease affect? Majority of people with FMD have it in multiple vessels More common in women Most affected age 30-50
Types of FMD FMD type is determined by which layer of the vessel wall is most affected 5 Types Medial fibroplasia Intimal fibroplasia Perimedial fibroplasia Medial hyperplasia Periarterial hyperplasia
Types of FMD Medial fibroplasia Intimal fibroplasia Periarterial hyperplasia
Medial Fibroplasia Most common form of FMD 75-80% of known cases Type discovered in case study Affects the tunica media (middle layer) Form of FMD that displays the string of beads
Intimal fibroplasia < 10% of cases Deposits made of Collagen (a fibrous tissue) form along the tunica intima (the inner wall of the artery) Smooth narrowing sections of artery are visualized No beading is visible
Perimedial fibroplasia < 10% of all cases Collagen deposits in the outer part of the tunica media Causes thickening of vessel walls Bead on a string look with beads appearing smaller than the normal artery Increased risk of occlusion in diseased arteries
Medial hyperplasia Only 1-2% of all cases Extreme formation of smooth muscle cells Areas of smooth narrowing visible on angiogram.
Periarterial hyperplasia Most rare form < 1% of all cases Adventitia (outer layer of arterial wall) expands Collagen widens into surrounding adipose layers Artery and surrounding area is inflamed
Causes of FMD No known cause 10% of cases are inherited Possible suggested causes Hormones (Estrogen) Internal stress or trauma causing damage to vessel walls External Factors such as smoking
Possible Locations Most common locations Renal arteries Carotid arteries Vertebral arteries Less common locations Abdominal arteries Arteries of extremities
FMD in Carotid Arteries
FMD in Renal Arteries
Signs and Symptoms Vary depending of diseased area Renal Artery Hypertension Abdominal bruit Diminished kidney function
Signs and symptoms Carotid or Vertebral Artery Headache (Migraine) Audible bruit Ringing or whooshing in ear Lightheadedness Severe cases may cause Facial droop TIA/Stroke Carotid Artery Dissection Causes headache and sudden neck pain Higher risk for brain aneurysm
Signs and Symptoms Other abdominal vessels Pain after eating Unexplained weight loss Abdominal bruit Arms or Legs Claudication in affected limb
Treatment Treatment depends on location and severity of disease Symptoms are controlled Medication for renal hypertension Headache medications available Aspirin may be suggested
Treatment If an aneurysm has formed in the brain or renal artery, immediate surgery may occur In cases with severe narrowing of the vessel, angioplasty may be necessary. Used in the carotid arteries when narrowing is causing a TIA or stroke Used in renal arteries when hypertension cannot be controlled Rare cases require stenting
Treatment Patients will often be monitored at least once a year to check for progression of disease
Conclusion FMD is a disease that affects the arteries Excessive cell growth inside the vessel wall Most commonly affects women ages 30-50 Treatment varies with severity and location of disease The most common type is Medial fibroplasia Appears as string of beads in ultrasound and angiography
References Cleveland Clinic. (2014). Fibromuscular dysplasia (fmd). Retrieved from http://my.clevelandclinic.org/heart/disorders/vascular/ fibromuscular_dysplasia.aspx Gornik, H. L., Mace, P., Olin, J. W., & Poloskey, S. L. (2012, January 10). Fibromuscular dysplasia. Retrieved from http://circ.ahajournals.org/content/125/18/e636.full Shah, C., Tuckman, T., Lown, L., & Johnson, P. (2014). Bilateral fibromuscular dysplasia of the carotid artery. Retrieved from http://sonoworld.com/casedetails/bilateral_fibromusc ular_dysplasia_of_the_carotid_artery.aspx?modulecat egoryid=320