CTICasesHigh-Grade Aortic Coarctation (Near-Atresia)
Imaging findings
An adolescent with previously undiagnosed aortic coarctation has 3D surface renderings and sagittal CT showing no apparent luminal connection between the proximal and distal aorta at the coarctation, with an attenuation difference between proximal and descending aorta reflecting collateral supply. There are extensive collaterals, including superficial chest wall vessels and hypertrophied intercostal and internal thoracic arteries, and rib notching that is more prominent along the lower ribs. The proximal arch is also small and atretic.
Key takeaways
A high-grade coarctation with no demonstrable luminal connection may be termed near-atresia and can overlap clinically with an interrupted arch, though the arch itself is not interrupted. Extensive collateral supply produces rib notching (more marked inferiorly) and hypertrophied intercostal and internal thoracic arteries, and associated hypoplasia of the proximal arch can be inferred on lateral radiographs by absence of the aortic shadow behind the trachea. Whether a residual lumen exists determines whether percutaneous covered-stent recanalization versus a hybrid approach is feasible.
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