• Images in cardiology

A 60 year old man was referred for diagnostic evaluation of severe right arm hypertension and suspected aortic coarctation. Hypertension and a systolic murmur were diagnosed when he was 20 years old. The patient suffered from a stroke a few months before admission. Physical examination revealed a grade 3/6 systolic murmur at precordium radiating to the mid back, and weak and delayed femoral pulses. Blood pressure was 185/90 mm Hg in the right arm and 130/75 mm Hg in the left arm. The chest x ray revealed rib notching caused by congestive collateral circulation. Thoracic magnetic resonance (MR) angiography demonstrated an extreme coarctation at the isthmus of the aorta, and a tight ostial stenosis at the origin of the left subclavian artery originating from the stenotic segment. The left internal mammary artery appeared hypertrophic and tortuous (left panel). Catheterisation showed a mean pressure gradient of 60 mm Hg across the coarctation. Angiography confirmed the MR diagnosis (right panel).

Gadolinium enhanced three dimensional breath hold MR angiography of the thoracic aorta. Black arrow indicate isthmic coarctation; white arrow indicate left subclavian artery stenosis; ITA indicates internal thoracic artery.

Conventional angiography of the thoracic aorta.