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A 40 year old woman presented with an abnormal chest radiograph without any symptoms. She had no history of hypertension. On examination she had a regular pulse and normal range of blood pressure measured at each extremity. The chest radiograph revealed a large mass with features suggesting an aortic anomaly including peripheral linear calcification and a tubular and tortuous opacity, the outline of which was smoothly continuous to the descending thoracic aorta (panel A). Conventional x ray aortography failed because the catheter inserted via the right femoral artery could not pass over the tortuous aortic arch in order to get the tip located proximal to the arch for contrast injection. The patient underwent contrast enhanced, magnetic resonance angiography. Three dimensional reconstructed images demonstrated an extremely elongated and approximately three-turned, helical, aortic arch with multiple saccular aneurysms in the anteroposterior (panel B) and oblique lateral (panel C) views. The more caudal origin of the left subclavian artery was clearly depicted in the posterior view of the three dimensional image (arrow in panel C). This congenital anomaly consisting of redundancy of the aortic arch without any significant obstruction has been known as pseudocoarctation. Surgical intervention was considered but rejected because of the absence of symptoms, complications, any evidence of risk of rupture, and associated cardiac abnormalities related to pseudocoarctation in this patient.
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