Coarctation of aorta

Case contributed by Aditya Shetty


History of hypertension for 1 year. Feeble pulses in lower limbs.

Patient Data

Age: adult
Gender: Male
Inferior rib notching noted in the 3rd, 4th, 5th and 6th posterior ribs.

An extensive well developed collateral system is noted in the anterolateral chest wall, thorax, abdomen and in the muscular plane along the back.

Angiographic examination of the aorta shows a focal area of narrowing and constriction with dilatation of aorta proximal and distal to the narrowed segment.

Collateral pathways have developed through the internal mammary, long thoracic, intercostal, spinal, vertebral and superior epigastric arteries.

Case Discussion

Coarctation of the aorta is an abnormality of the aortic media and intima leading to narrowing of the lumen. Narrowing is seen distal to the origin of the left subclavian artery. It accounts for 5%-10% of all congenital cardiac conditions. It is known to be associated with Turner's syndrome.

Two types are known:

  • infantile pre-ductal type
  • adult post-ductal type

Infants present with congestive heart failure with failure to thrive and adults present with hypertension and difference in blood pressures between upper and lower extremities.

Rib notching (inferior) is a common x-ray finding in adult type as the dilated tortuous intercostal arteries form grooves on the undersurface of the ribs.

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