How to distinguish between inconsistencies in CTA results and DSA findings: interobserver variability cannot be ignored.

Renovascular hypertension (RVH) is a common cause of secondary hypertension. Noninvasive tests such as computed tomography angiography (CTA) or magnetic resonance angiography have a high specificity and sensitivity for the diagnosis. Digital subtraction angiography (DSA) is, however, the gold standard with which RVH can be reliably diagnosed. We report the case of a 30-year-old Chinese man with right ureter malformation and stenosis of the entire right renal artery. We discuss how to distinguish between inconsistencies in CTA results and DSA findings. Interobserver variability is an important factor that leads to such inconsistencies and cannot be ignored. Importantly, clinicians should combine imaging findings with the patient's medical history and clinical manifestations rather than blindly believing the DSA results so as to avoid unnecessary medical disputes.