Pseudocoarctation of the aorta

Last revised by Dr Joachim Feger on 19 Jul 2021

Pseudocoarctation of the aorta is a very rare anomaly characterized by kinking or buckling of the descending aorta at the level of the ligamentum arteriosum without a pressure gradient across the lesion.

It is thought to be of congenital origin, and characterized by elongation and kinking of the aorta at the level of the ligamentum arteriosum.

Its exact etiology not well known. One proposed embryologic cause is a failure of compression of the third through the seventh segments of the dorsal aortic roots and the fourth arch segment.

Rarely reported associations include 3:

The following features have been shown to be useful in diagnosis (according to case reports) 3:

  • demonstration that the abnormal mass in the mediastinum is part of the aorta
  • unusually aortic arch high in the mediastinum
  • 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.

It is thought to have been first described by Dotter, Steinberg, Souders and co-workers in 1951 3,5.

Consider the true coarctation of the aorta

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Cases and figures

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