Pseudocoarctation of the aorta
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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.
Rarely reported associations include 3:
aneurysmal dilatation beyond 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.
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.
Treatment and prognosis
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.
History and etymology
It is thought to have been first described by Dotter, Steinberg, Souders et al. in 1951 3,5.
Consider true coarctation of the aorta:
evidence of collateral circulation (e.g. rib notching)
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