• Images in cardiology

A previously healthy 21 year old man first presented with subarachnoid haemorrhage secondary to a right posterior communicating artery aneurysm, which was surgically clipped. He was discovered to be hypertensive, and clinical signs were suggestive of aortic coarctation. Echocardiography confirmed the presence of a severe coarctation. Continuous wave Doppler interrogation of the descending aorta from the suprasternal approach recorded a peak velocity of 4.4 m/s and significant diastolic forward flow. However, the anatomy around the coarctation was not well defined because of tortuosity of the coarctation segment. Contrast enhanced magnetic resonance angiography (CE-MRA) was requested before surgical intervention. The presence of a Sugita brain aneurysm clip (which is made of a cobalt chrome alloy) did not contraindicate CE-MRA—a fact confirmed by consulting both the manufacturer and available safety databases. Maximal intensity projection image of CE-MRA in the left anterior oblique view (left) revealed a focal tight (diameter 6 mm) juxtaductal coarctation (arrow), immediately distal to the origin of the left subclavian artery. An extensive network of enlarged and tortuous collateralising intercostal and internal mammary arteries is evident. The patient was rescheduled for early operative repair of the severe coarctation.

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