SHM Converge Scientific Abstract ePoster Gallery-The Misdirection of Celiac Artery Dissection

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<strong>Summary: Fibromuscular Dysplasia versus Vasculitis</strong>

A 57-year-old woman with undifferentiated connective tissue disease, hypertension, hyperlipidemia, and recent COVID-19 infection was hospitalized for worsening chest and left upper quadrant abdominal pain. During a prior admission, CT abdomen had been interpreted as <strong>celiac artery vasculitis</strong> with splenic artery thrombosis and splenic infarcts. She improved after treatment with <strong>high-dose steroids, methotrexate, and apixaban</strong>, and was discharged with rheumatology follow-up.

On this admission, inflammatory markers were markedly elevated (**ESR 103, CRP 71**), but <strong>ANCA and hepatitis testing were negative</strong>. CTA head/neck showed <strong>undulating arterial contours</strong> in the proximal right vertebral artery and proximal left internal carotid artery, a pattern more consistent with <strong>fibromuscular dysplasia (FMD)</strong> than vasculitis.

This case highlights an important diagnostic pitfall: <strong>FMD can mimic vasculitis</strong>, especially when abdominal or cerebrovascular imaging shows arterial narrowing, aneurysm, or dissection. FMD is a <strong>non-inflammatory disease of small and medium arteries</strong>, classically producing the <strong>“string of beads”</strong> appearance on angiography. In contrast, vasculitis is inflammatory and usually presents with <strong>systemic symptoms</strong>, elevated acute-phase reactants, and imaging showing more <strong>tubular narrowing</strong>.

Recognizing FMD matters because misdiagnosis can delay correct care and expose patients to harmful therapy. In particular, <strong>steroids and immunosuppression</strong> used for vasculitis may weaken the arterial wall and increase the risk of <strong>dissection or rupture</strong>.

Management of FMD centers on <strong>blood pressure control, smoking cessation, and antiplatelet therapy</strong>, with further vascular evaluation as needed.

<strong>Key point:</strong> In patients with arterial narrowing and dissection, consider <strong>FMD before vasculitis</strong>, especially when imaging suggests a non-inflammatory vascular pattern.

Asset Subtitle

Alexandra Lee

Meta Tag

Author List Alexandra Lee

Category Clinical Vignettes

Concept Fibromuscular Dysplasia

Concept Vasculitis

Concept String of Beads Appearance

Concept Angiographic Findings

Concept Blood Pressure Control

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Alexandra Lee

Track Adult

Keywords

fibromuscular dysplasia

vasculitis

string of beads

arterial narrowing

arterial dissection

celiac artery

splenic infarcts

CTA head neck

high-dose steroids

antiplatelet therapy

Fibromuscular Dysplasia

Vasculitis

String of Beads Appearance

Angiographic Findings

Blood Pressure Control