Patient History
A 30-year-old woman complains of shortness of breath during exercise. The patient denies smoking or any previous lung problem. The physical examination reveals a systolic heart murmur and a pulse difference between arm and legs. An echo was performed and demonstrated normal left ventricular function, normal heart valves but a turbulent flow at proximal descending aorta. MR Angiography (MRA) of the aorta was requested for diagnosis of a suspected aortic coarctation.
Image Findings
The MRA was reconstructed with different techniques and confirmed the diagnosis of coarctation of the aorta. However, this also revealed an aberrant left subclavian artery. This diagnosis is an important point for surgical planning since reimplantation of the artery will be required. Thin maximum intensity projections (thinMIP) images (Fig. 1) illustrate the findings. In addition, Volume Rendering Technique (VRT) (Fig. 2) in different projections and colors demonstrates the vascular anomaly.
Fig. 1 ThinMIP reconstruction image of the thoracic aorta with
coarctation of the aorta and aberrant left subclavian artery.
Fig. 2a-2e Posterior view with VRT images
demonstrating the vascular anomalies.
Results and Discussions
Coarctation of the aorta is one of the most common congenital heart diseases and is often under-diagnosed. The patient has symptoms only with severe aortic obstruction. Usually the vascular anomaly is suspected during a routine physical examination due to heart murmur or a pulse difference between upper and lower limbs. Echo is the first choice and often has difficulty in visualizing the arch and the proximal portion of the descending aorta. Conventional angiography was used in the past, but currently its use is not acceptable due to risks related to the procedure. A good quality diagnostic image is essential to determine location and severity of lesion. And magnetic resonance angiography has become the non-invasive procedure of choice due to an entire noninvasive visualization of the thoracic aorta. Multislice CT may be also used, but has the inconvenience of nephrotoxic contrast media and radiation exposure in usually young patients. This case characterizes a typical patient with long-standing aortic coarctation which is easily diagnosed by MRA.