What Is Your Diagnosis ? What conditions should be included in the differential diagnosis?

A 60-year-old white man with a history of coronary artery disease, peripheral vascular
disease status post-femoral artery–posterior tibial artery bypass grafting, osteoarthritis,
and a 3-year history of hypertension presents to the clinic for a routine blood pressure
check. He has had no complaints since his last checkup 6 months ago. He is taking
hydrochlorothiazide, metoprolol, lisinopril, diltiazem, pravastatin, and aspirin. Vital
signs include a temperature of 37.0°C (98.6°F), blood pressure of 160/95 mm Hg, pulse
rate of 70/min, and respiratory rate of 10/min. His physical examination is notable for
an abdominal bruit auscultated to the right of midline at the level of the umbilicus.
Laboratory values are as follows:
Sodium: 140 mEq/L
Potassium: 4.1 mEq/L
Chloride: 98 mEq/L
Bicarbonate: 23 mEq/L
BUN: 22 mg/dL
Creatinine: 1.8 mg/dL
Glucose: 110 mg/dL
A magnetic resonance angiogram (MRA) is ordered, and shown in Figure