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Visceral fibromuscular dysplasia in a patient with chronic abdominal pain

A 61-year-old woman presented to our hospital complaining of months of episodic postprandial abdominal pain with weight loss, malnutrition, and multiple outside hospital admissions. She also had a history of basilar artery aneurysm and hypertension. Comprehensive laboratory testing excluded autoimmune, inflammatory, or infectious etiologies. Computed tomographic angiography (CTA) of the abdomen revealed multiple aneurysms and stenoses of the superior and inferior mesenteric arteries (SMA and IMA, respectively). Invasive angiography confirmed that the SMA (Panel A) had diffuse stenoses and multiple aneurysms of its branch vessels. Similarly, the IMA (Panel B) had large aneurysms and slow flow. Renal artery angiography (right renal artery in Panel C) showed aneurysms alternating with stenoses. Our working diagnosis was mesenteric ischemia caused by multifocal fibromuscular dysplasia (FMD) of the visceral arteries.1 However, segmental arterial mediolysis and quiescent polyarteritis nodosa could not be definitively excluded by imaging alone. Therefore, laparoscopic biopsy of the left colic artery was performed.