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Treatment of Hypertension from Renal Artery Entrapment by Percutaneous CT-Guided Botulinum Toxin Injection into Diaphragmatic Crus as Alternative to Surgery and Stenting

Aslan Bilici1, Musturay Karcaaltincaba2, Ahmet Turan Ilica3, Yasar Bukte1 and Ayhan Senol1

1 Department of Radiology, Dicle University, 21280, Diyarbakir, Turkey.
2 Department of Radiology, Hacettepe University, Ankara, Turkey.
3 Department of Radiology, Diyarbakir Military Hospital, Diyarbakir, Turkey.


Figure 1
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  		Fig. 1A —25-year-old woman who presented with headache and hypertension. Axial CT image shows stenotic proximal left renal artery (arrow), which is displaced medially by diaphragmatic crura (arrowhead).

 

Figure 2
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  		Fig. 1B —25-year-old woman who presented with headache and hypertension. Coronal reformatted image shows normal right renal artery origin (arrow). Left renal artery origin is stenotic and courses inferiorly and medially from its origin (arrowhead). Diaphragmatic crus (star) is seen displacing and compressing left renal artery medially.

 

Figure 3
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  		Fig. 2A —25-year-old woman who presented with headache and hypertension. Transverse CT scan obtained with patient in prone position shows 21-gauge needle (arrow) passing between rib and spinous process toward diaphragmatic crura.

 

Figure 4
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  		Fig. 2B —25-year-old woman who presented with headache and hypertension. Transverse CT scan obtained with patient in prone position shows 21-gauge needle is placed at center of left diaphragmatic crus (arrow).

 

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