Pseudocoarctation of the aorta

Case contributed by Ian Bickle


Cough. Primary care request.

Patient Data

Age: 50 years
Gender: Male

Mediastinal contour gives the impression of 'two aortic arches'. Smooth soft tissue bulge superior to the arch.

Heart size normal.

Azygos fissure.  Lungs clear.

The aorta distal to the origin of the left subclavian artery is elongated and redundant with buckling and apparent luminal narrowing. 

A small segment dilation of the descending thoracic aorta distal to the buckling.

The heart is normal in size and contour.

No dissection or collateral circulation. 

Anomalous left common carotid arising from the brachiocephalic artery.

Case Discussion

Aortic pseudocoarctation is a very rare congenital anomaly of the aortic arch and can coexist with other congenital heart diseases, such as a bicuspid aortic valve.

It mimics true coarctation, but can be differentiated from it by recognizing a high, elongated arch, a kinking that lacks luminal narrowing and an absence of enlarged collateral arteries.

The identification of aortic pseudocoarctation can be an incidental finding, as in this case, or associated with hypertension and symptoms related to compression of adjacent structures.

Its management is not well established, although if asymptomatic no action is required, however surgical treatment has been proposed in symptomatic patients or when associated with aortic aneurysms.

Case courtesy of Dr Mohsen Alkmeshi, Nottingham University Hospitals, UK.

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