Popliteal aneurysm due to fibromuscular dysplasia

Progesterone receptor expression in fibromuscular dysplasia: A report of two unusual cases

Fibromuscular dysplasia is rarely biopsied. Progesterone receptor expression in myofibroblastic cells is useful for the histopathological evaluation in difficult-to-diagnose cases. Herein, we report two unusual cases of fibromuscular dysplasia in which progesterone receptor expression was shown in vessel sections.

Fibromuscular dysplasia of the lower extremities

Fibromuscular dysplasia (FMD) is a nonatherosclerotic, non-inflammatory vascular disease that mainly affects the renal and internal carotid arteries. Involvement of other sites, including arteries of the extremities, is uncommon, and only a few histologically confirmed cases have been reported. FMD of the arteries of the extremities can result in ischemia requiring surgical or endovascular reconstruction. In the present report, two cases of FMD are described: one case of femoropopliteal artery occlusive disease, and one case of nonsymptomatic progression of external iliac artery dissection, both with histological confirmation of FMD. Clinical presentation, treatment, outcome and histological findings of previously reported cases are reviewed. FMD should be considered as a cause of occlusion, stenosis, dissection or aneurysm of the peripheral arteries: although rare, it can lead to limb-threatening ischemia or life-threatening aneurysm rupture.

Fibrodysplastic popliteal aneurysm and dilatation of pedal artery

We report a case of an asymptomatic popliteal aneurysm due to fibromuscular dysplasia (FMD), associated with suspected FMD of pedal artery on a 63-year-old woman. The popliteal aneurysm was resected. An in situ interposition of a short segment of hypogastric artery was performed to restore the arterial continuity. Popliteal FMD was confirmed by histological findings. Only 5 cases are reported in literature. FMD of pedal artery was suspected on the CT-scan aspect. FMD is a rare cause of popliteal aneurysm. To our knowledge, this is the first report of suspected fibrodysplastic dilatation of a foot artery.

Fibromuscular dysplasia: when is intervention warranted?

Fibromuscular dysplasia is a multifactorial arteriopathy that primarily affects small and medium-sized arteries. It is most common in the renal and internal carotid arteries. Pathological classification is based on the arterial wall layer most significantly involved. The natural history and incidence of asymptomatic disease is unknown. The most common lesions become symptomatic as a high-grade stenosis producing renovascular hypertension or as an embolic source for the cerebral circulation. Treatment is reserved for symptomatic lesions. Most simple lesions are effectively treated by catheter-based intervention. Surgical therapy is warranted for more complex lesions. Both produce durable, long-term results.

Intramural coronary artery dysplasia of the ventricular septum and sudden death

We report four cases of sudden unexpected death in three males and one female aged 12 to 31 years. Death occurred during exercise in three of four cases, and there was no history of sudden death or previous cardiac history in any patient. At autopsy, there was marked intramural coronary artery dysplasia of the ventricular septum, accompanied in three of the four cases by myocardial fibrosis. The arterial dysplasia was characterized by severe medial thickening with smooth muscle cell disorganization and marked luminal narrowing. There was no evidence of myofiber disarray or asymmetric septal hypertrophy to suggest hypertrophic cardiomyopathy. Other than an ostium secundum type atrial septal defect in one case, there were no associated cardiac or extracardiac lesions found at complete autopsy of these individuals. We conclude that small vessel disease of intramural coronary arteries of the ventricular septum may be an isolated finding leading to sudden cardiac death in young adults.