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A 30-year-old male patient presented with a long history of exertional dyspnea and palpitations. Clinical examination revealed differential blood pressure between the upper and lower limbs and a significant radiofemoral pulse delay. CT angiography revealed a focal tight coarctation of the aortic isthmus (Figure, A; Movie), with extensive collateral circulation bypassing the site of coarctation (Figure, B–G; Movie).
Aortic CT angiography in a 30-year-old male patient presenting with a long history of exertional dyspnea and palpitations. (A) Oblique sagittal reconstruction image shows tight coarctation (arrowhead) in the region of isthmus with prestenotic (3) and poststenotic (4) dilatation of the descending thoracic aorta. (B) Coronal maximum intensity projection image shows the internal mammary arteries (5) dividing to form the musculophrenic branch, which gives rise to the lower (seventh to ninth) anterior intercostal arteries (6) and the superior epigastric arteries (7). The superior epigastric arteries anastomose with the inferior epigastric arteries (8) arising from the external iliac arteries (9). (C–F) Cinematic rendered images show the lateral thoracic arteries (11) and the thoracodorsal branch (12) of the subscapular arteries (10) and dorsal (or descending) scapular artery (13) forming a parascapular collateral network, which anastomoses with the lower (seventh to ninth) posterior intercostal arteries (14) and the upper (third to sixth) posterior intercostal arteries (15), respectively. (G) Cinematic rendered image shows the direct mediastinal branches (16) supplying the postcoarctation segment.1 = left subclavian artery, 2 = left common carotid artery.
Movie:
Axial CT angiography cine images in a 30-year-old male patient of the aorta and its branches.
A small proportion of patients with coarctation of the aorta may present for the first time in adulthood. This is usually associated with an abundant collateral network supplying blood from the high-pressure circulation to the low-pressure circulation distal to the coarctation (1,2). Multiple hypertrophied branches of the subclavian artery and axillary artery supply blood to the poststenotic descending thoracic aorta via the third to ninth posterior intercostal arteries. The superior epigastric artery from the internal mammary artery anastomoses with the inferior epigastric artery and supplies blood to the external iliac artery.
Acknowledgments
Acknowledgments
We acknowledge the support of the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, in the patient’s management.
Footnotes
Authors declared no funding for this work.
Disclosures of conflicts of interest: N.N.P. No relevant relationships. S.T.V. No relevant relationships. S.K. No relevant relationships.
Keywords: CT Angiography, Image Postprocessing, Vascular, Aorta
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