[Unstable hypertension due to renal artery compression by the developed diaphragm in a 17-year-old athlete: a case report].

A 17-year-old high school boy was admitted to our hospital because of hypertension. Doppler ultrasound of the renal arteries and 3D-CT angiography showed a stenosis of the right renal artery, which was pushed against the aorta by the right crus of the diaphragm. He underwent aortography and selective renal arteriography. His right renal artery originated from the aorta at a higher level than the left renal artery, between the celiac artery and the superior mesenteric artery. Renal arteriography confirmed a 50% reduction in diameter (stenosis) of the proximal right renal artery entrapped by the right diaphragmatic crus. This pathology, unlike common renal artery stenosis, sometimes requires surgical decompression or an aortorenal bypass graft, because renal angioplasty with stenting is reported to be at risk of complication by a fracture of the stent. However, the patient rejected surgical decompression for fear of deterioration of his athletic ability. Therefore we decided to follow up his blood pressure and renal size by ultrasound every six months. Renovascular hypertension caused by diaphragmatic entrapment is a very rare disease. The diagnosis may be overlooked easily at angiography if optimal views are not obtained. It is important to display images of the renal arteries, the celiac artery and the superior mesenteric artery in both inspiration and expiration.