A Unique Case of Renovascular Hypertension due to Fibromuscular Dysplasia in an Extra-renal Artery.

A 33-year-old man was admitted to our hospital to undergo an evaluation to determine the cause of secondary hypertension. Computerized tomography angiography (CTA) showed bilateral multiple renal arteries with significant stenosis of the right extra-renal artery due to fibromuscular dysplasia and segmental impairment of renal perfusion. Although the plasma aldosterone concentration and plasma renin activity were within the normal ranges, percutaneous balloon dilatation of the stenotic lesion resolved his hypertension, leading to a diagnosis of renovascular hypertension caused by segmental renal ischemia due to extra-renal artery stenosis. CTA should be considered during the examination of patients with early-age hypertension, even if the plasma renin activity is not sufficiently elevated.

Pulmonary arterial sampling was useful for localizing ectopic ACTH production in a patient with bronchial carcinoid causing Cushing syndrome.

OBJECTIVE: We report a 44-year old man with ectopic adrenocorticotropic hormone (ACTH) syndrome caused by bronchial carcinoid that developed Cushing syndrome. METHODS: We performed several imaging studies, including chest and abdominal CT, for exploration of nodules and selective pulmonary arterial sampling for localizing a source of ectopic ACTH production. RESULTS: The patient was diagnosed as Cushing syndrome due to ectopic production of ACTH without identification of its source(s). After 2 years' follow-up with repeated CT scans every 6-12 months and treatment with metyrapone, chest CT revealed two small nodules respectively in the segment (S) 4 and 10 of the right lung. We performed selective pulmonary arterial sampling from branches of the right pulmonary artery to obtain blood from the nodules in a reverse flow fashion: wedged sampling from the basal branch (A8, 9 and 10) revealed significant elevation of ACTH, whereas sampling from the lateral branch (A4) did not, indicating that the S10 nodule produced ACTH ectopically. The video-assisted thoracoscopic surgery removing the right inferior lobe normalized plasma ACTH, serum cortisol and 24-hour urinary free cortisol. The S10 nodule was histologically diagnosed as atypical bronchial carcinoid containing immunoreactive ACTH. CONCLUSIONS: Selective pulmonary arterial sampling was useful for localizing the lesion of ectopic ACTH production and helped make the decision for its surgical removal. This procedure should be considered once lung nodules suspicious for ectopic ACTH production are identified in patients with EAS.

Inflammatory pseudotumor in the lateral ventricle. Case report.

A 15-year-old boy was referred to our hospital with a rare case of inflammatory pseudotumor (IP) in the lateral ventricle manifesting as complaints of headache and low-grade fever. Computed tomography and magnetic resonance imaging demonstrated a well-demarcated and enhanced tumorous lesion in the right lateral ventricle. Intraoperative findings showed a hard mass with feeding arteries from the choroid plexus around the foramen of Monro in the right lateral ventricle, although the mass was not attached to the wall of the lateral ventricle. The lesion was totally resected, and the histopathological diagnosis was IP. The present and previous cases suggest that good outcomes are obtained by surgical removal and treatment of hydrocephalus. IP should be considered in the differential diagnosis of hard tumorous lesions with good enhancement and no tumorous staining in the ventricle.