Pseudocoarctation of the aorta

Last revised by Liz Silverstone on 25 Nov 2024

Pseudocoarctation of the aorta is a rare anomaly characterized by elongation of the aortic arch associated with buckling at the level of the ligamentum arteriosum.

Reported associations include 3,9:

The CT appearance is characteristic, however, the definition depends on the catheter measurement of pressure gradient <20 mmHg ref. The absence of collateral arteries is important to distinguish pseudocoarctation from coarctation.

If the patient is asymptomatic with no evidence of complications, such as dissection or aneurysm, a CT diagnosis is sufficient.

An analysis of 18 cases from the literature could show bias towards symptomatic patients; the presentations were as follows9:

  • hypertension (55%), half with unequal upper limb blood pressure

  • dyspnea (17%)

  • back pain due to dissection (11%)

  • dysphagia (6%)

  • asymptomatic (11%j

It is thought to be congenital, due to less than normal compression of the third to seventh dorsal aortic segments. The increased length accounts for the high position of the aortic arch and associated buckling.

The following features are useful in diagnosis (according to case reports) 3:

  • demonstration that the abnormal mass in the mediastinum is part of the aorta

  • unusually superior location of the top of the aortic arch

  • visualization of the isthmic portion of the descending thoracic aorta that's not adjacent to the spine, but rather ventral to it; this is surrounded by aerated lung

  • a more caudal origin of the subclavian artery

Other reported features include 2:

  • the aortic arch of pseudocoarctation is elongated and may arise higher than the clavicle (associated with cervical aortic arch)

  • absence or only a mild degree of stenosis of the aortic lumen

  • the absence of collateral circulation

  • the absence of left ventricular hypertrophy and ascending aortic dilation

Cardiac catheterization and angiography provide a definitive diagnosis.

It is considered a benign entity with no specific intervention 8. Some advocate surgical treatment for all symptomatic patients and those with associated aneurysm formation 7.

The first description of pseudocoarctation have been attributed to the Austrian Hugo Rösler and his American college Paul White in 1931 10,11. Later Dotter, Steinberg, Souders et al. described additional cases in 1951 3,5.

Consider true coarctation of the aorta:

Cases and figures

  • Case 1
  • Case 2
  • Case 3
  • Case 4
  • Case 5: with dextrocardia
  • Case 6

Imaging differential diagnosis

  • Coarctation of the aorta
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