A Rare First Presentation of Unilateral Fibromuscular Dysplasia Resulting in Renal Infarct

A rare first presentation of unilateral fibromuscular dysplasia (FMD) in an African American patient in her 60s, with renal infarct, is described, along with imaging. The patient presented with acute-onset right-sided abdominal pain and severe hypertension not responding to multiple antihypertensives. She was found to have renal infarcts on the right side. Further imaging with computed tomography angiography (CTA) and duplex scan were suspicious for FMD on the right side. The diagnosis was confirmed by selective renal digital subtraction angiography, and the patient underwent a successful balloon angioplasty of the right renal artery with resolution of her symptoms and hypertension. The presentation is unusual because of her age and ethnicity. The case is discussed along with differential diagnoses. This case also illustrates that socioeconomic disparities can affect early diagnosis, and eventually the outcome, in healthcare.