Flash pulmonary edema and the diagnostic suspicion of Pickering syndrome

Excerpt

A 26-year-old woman with nocturnal flash pulmonary edema and poorly controlled hypertension was referred to our institution. She presented after her first episode, which came on abruptly at night. Her serum creatinine level and echocardiogram were normal. Abdominal angiography showed subtotal occlusion of the bilateral renal artery due to fibromuscular dysplasia (Fig. 1). A stent was implanted in the left artery occlusion (6.0 × 18 mm Genesis at 12 atm) at the lesion (Fig. 2). Subsequently, two overlapping stents (6.0 × 18 mm Genesis at 12 atm; 7.0 × 18 mm Genesis at 12 atm) were implanted in the proximal right renal artery (Fig. 3). Angiography showed no residual stenosis after stent implantation. During the first week after revascularization, the patient’s blood pressure was maintained below 140/90 mmHg. At the 1-year follow-up, the patient was free of pulmonary edema and hypertension. …