CTICasesAortic Coarctation with Disproportionately Dilated Descending Aorta
Imaging findings
A 34-year-old with chest pain and radiographic tracheal deviation and an old healed rib fracture deformity has a CT showing focal aortic narrowing consistent with coarctation, accompanied by substantial intercostal and internal mammary collateral vessel formation and corresponding rib notching on radiograph. The descending aorta distal to the coarctation is disproportionately dilated, measuring nearly 3 cm, more than would be expected from coarctation alone; the patient also has numerous unexplained skin nodules.
Key takeaways
True coarctation with hemodynamically significant narrowing produces intercostal and internal mammary collateral formation and rib notching, distinguishing it from pseudocoarctation; disproportionate dilation of the descending aorta beyond what coarctation alone would explain, together with unexplained skin lesions, raised concern here for an underlying connective tissue or vasculopathic syndrome (such as Loeys-Dietz) rather than isolated coarctation.
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