Entrapped renal artery in the left crux of diaphragm: a rare cause of malignant hypertension

摘要

A 36-year-old obese female presented with acute onset headache, vomiting, and weakness of right side of the body. Her blood pressure was noted to be 220/140 mmHg. On physical examination, she had right-sided hemiparesis. Fundoscopy showed Grade 1 hypertensive retinopathy. No renal bruit was audible. Electrocardiogram revealed left ventricular hypertrophy (LVH). On echocardiography, she had concentric LVH, with normal left ventricular systolic function and Grade 1 diastolic dysfunction. Computed tomography (CT) scan head revealed intracranial haemorrhage (left basal ganglia bleed) ( ) She was managed with intravenous labetolol, furosemide, and oral amlodipine. Gradually, the intravenous drugs were discontinued and oral medications including amlodipine, telmisartan, moxonidine, eplerenone, and furosemide optimized. Serum biochemistry including renal functions was unremarkable. Ultrasound abdomen revealed normal kidney size. Renal Doppler was suggestive of ( ) in the intra-renal branch of the left renal artery. A CT aortogram revealed a discrete narrowing of the left renal artery due to entrapment by the left crux of diaphragm. There was no evidence of atherosclerosis or calcification of the renal artery ( and ; ).