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A 16 year old girl came to our department for evaluation of severe hypertension. She was asymptomatic but clinical examination showed signs suggestive of coarctation of aorta. ECG showed left ventricular hypertrophy with strain pattern. Chest radiography showed normal cardiothoracic ratio, prominent smooth bulge in left upper cardiac silhouette, and bilateral rib notching. Echocardiography revealed concentric left ventricular hypertrophy and coarctation segment just after the origin of left subclavian artery. However, the aorta distal to the coarctation segment was not well visualised.
Doppler echocardiography detected peak gradients of 78 mm Hg across the coarctation segment. On cardiac catheterisation pull back aortic gradients of 80 mm Hg were recorded. Angiocardiography showed severe coarctation of the aorta just distal to the origin of the left subclavian artery and a huge postcoarctation aortic aneurysm (open arrow) with calcification in its wall (closed arrow). Findings were confirmed during surgery and the patient was treated successfully by resection of coarctation segment as well as postcoarctation aneurysm with graft tube interposition. She made an uneventful recovery.