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A 26 year old woman was referred following the discovery that her blood pressure greatly differed between her upper limbs (left arm 180/80 mm Hg, right arm 90/70 mm Hg). Her pulse was barely palpable in the lower limbs and in the right upper arm there was a pulse delay compared to the left upper arm. The diagnosis of coarctation of the aorta (CoA) was made based upon physical examination and echocardiographic findings.
The diagnosis of CoA could not explain the difference in blood pressure between the upper limbs and the higher reading in the left upper arm.
Magnetic resonance angiography revealed a discrete CoA at the isthmus level with associated mild poststenotic dilation and without significant collateral circulation. The origin of the right subclavian artery was located at the stenosis level and the vessel was hypoplastic. The left subclavian artery originated above the stenosis and was of normal calibre. The two common carotids originated directly from the aortic arch and were normal at their bifurcation. The circle of Willis was normal.
This case of CoA was somewhat unusual in that the origin of the right subclavian at the CoA level was abnormal while that of the left subclavian origin was not. This finding can explain the unusual finding of the physical examination where the patient’s blood pressure was higher in her left arm. This case illustrates the superiority of magnetic resonance angiography in the evaluation of CoA in adults. The patient underwent successful balloon dilatation and stent implantation.