CTICasesCoarctation of the Aorta with Classic '3 Sign'
Imaging findings
A chest radiograph shows a classic '3 sign' representing aortic coarctation, projecting lower than expected for the normal aortic knob. The lateral view confirms a shelf-like appearance. CT reveals coarctation of the aorta, which is not severely stenotic, with minimal rib notching or large intercostal collaterals. Phase contrast MRI with flow quantification demonstrates higher distal aortic flow (at the diaphragm) compared to proximal flow (below the coarctation), indicating hemodynamically significant collateral recruitment.
Key takeaways
The '3 sign' on a chest radiograph is a classic indicator of aortic coarctation. While collateral development (rib notching) is a sign of severity, its absence does not rule out hemodynamic significance. Phase contrast MRI with flow quantification can non-invasively assess the hemodynamic impact of coarctation by comparing proximal and distal aortic flow volumes, identifying significant collateral recruitment.
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