Aortic coarctation

Case contributed by Dr Arkadi Tadevosyan

Presentation

Pre-operative assessment.

Patient Data

Age: 30
Gender: Male
CT

Presurgical contrast enhanced CT scan demonstrating a marked narrowing of descending thoracic aorta at the level of where the ligamentum arteriosum inserts into the descending aorta and is distal to the left subclavian artery keeping with the infantile(pre-ductal) form of aortic coarctation. There are also a prominent dilatation and tortuosity of internal thoracic posterior, anterior intercostal,  musculophrenic and superior epigastric arteries.

X-ray

Ride central venous catheter with the tip at the cavo-atrial junction, no pneumothorax. Neutral position of endotracheal tube: the tip is about 5cm above carina, normal position of nasogastric tube: it descends and crosses the diaphragm in the midline, left sided thoracotomy tube placed at the 5-6th intercostal space without any kinking: associated subcutaneous emphysema is present and deep sulcus sign is also seen suggesting air in the pleural space.

Postsurgical posterolateral thoracotomy metallic fixation wires are noted.

Figure 3 sign of aortic contour abnormality is nicely demonstrated.

There is clearly seen bilateral 3rd to 9th inferior rib notching.

Lungs are clear.

Case Discussion

Bilateral inferior rib notching is indicating that the coarctation is distal to the origin of both subclavian arteries and bilateral collaterals are formed between internal thoracic(mammary) artery, anterior intercostal artery, posterior intercostal artery and descending aorta.

Contrast enhanced CT scan confirms the subtle x-ray findings that were consistent with aortic coarctation.

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Case information

rID: 53947
Published: 27th Jun 2017
Last edited: 14th Aug 2019
System: Vascular, Chest
Inclusion in quiz mode: Included

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