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I'd like to show you this case of FMD.

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These are images of a 67-year-old

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female who had coronary artery

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dissection and was being screened for

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FMD in both her brain and her kidneys.

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I'm gonna show you the brain.

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So first she didn't have neurologic symptoms.

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We quickly screened the brain

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on the non-contrast CT and don't

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see anything acute going on.

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So let's take a look at the vessels.

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So these are coronal reformats and we're

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going to start in the carotid vessel.

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So you can see the left common,

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um, and then internal curving up.

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And what I see is this spring of beads

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appearance kind of looks like corduroy to me.

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You can see that in the left

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internal carotid artery.

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So that looks like it might be FMD.

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It does have a little atherosclerotic disease, but

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this just does not look like atherosclerotic disease.

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So we're pretty sure that it's FMD.

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So it has a classic appearance.

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Let's look at the right carotid.

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So here's the right common and we can go

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into the internal or that's the external.

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Sorry.

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Here's the internal.

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And you can see there's also

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some dolichoectasia and a beaded

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appearance on the right side as well.

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So that's also FMD.

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And then, um, the vertebral arteries,

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we can look at those and left vertebral

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artery, maybe a little irregularity, same

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thing with the right vertebral artery.

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This definitely looks like a case of FMD.

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Let's take a look at the axial images.

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So here we go with the axial images

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and I'm just going to follow the

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left common carotid artery up.

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We see a little atherosclerotic disease

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with plaque at the bifurcation.

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There's not significant stenosis.

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Maybe mild stenosis.

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And then, as we go up, what you see is the

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vessel gets big, the vessel gets smaller.

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It looks like it's an accordion, kind of.

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And then the vessel gets

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smaller and it's very tortuous.

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So that's, that's, Pretty classic for FMD,

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and then the right side, we're looking at

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the right common, and right bifurcation,

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maybe a little soft plaque there, you can

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see, and then as you come up, it looks again,

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that string of beads appearance, tortuous,

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stilichoepatic, so that looks like FMD, and

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then we can look at the vertebral arteries as

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well, the right vertebral artery, Um, we'll

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follow that up, looks pretty normal, and

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then again, it's a little tortuous, slightly

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irregular, so that probably is also FMD, and

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then last, let's look at the left vertebral

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artery, uh, little atheromatous disease at

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the origin, and following it up, and it gets

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small, gets a little bit bigger right there.

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So again, definitely involvement of both carotid

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arteries in the right vertebral artery, probably

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involvement of the left vertebral artery.

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And this is, um, classic FMD and she

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kind of had a classic presentation

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of coronary artery dissection.

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I also wanted to show you the

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intracranial vessels and we can see

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that on these axial MIPS that the MCAs.

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Look normal, the anterior cerebral

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arteries look normal, the posterior

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cerebral arteries look normal.

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And then we'll just look at the posterior

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circulation on the coronal images, and

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you can see that the retubal basilar

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junction looks normal, the basilar,

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both PCAs look normal, and again, the

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MCA bifurcations and ACAs look normal.

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So that's what you'd expect with FMD.

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It tends to involve the carotid and retubal

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arteries and not the intracranial arteries.