CTICasesAortic Coarctation with Bicuspid Aortic Valve
Imaging findings
Chest radiograph demonstrates prominent rib notching along the undersurface of the posterior ribs bilaterally, consistent with enlarged intercostal collateral arteries from chronic aortic coarctation. The aortic arch contour is abnormal with an absent or diminished aortic knuckle, and on the lateral view the top of the aortic arch is not visible posterior to the trachea, a subtle but important sign of coarctation. CT sagittal reconstruction confirms severe narrowing at the isthmus with a small aortic lumen and prominent collateral vessels. A bicuspid aortic valve is also demonstrated, consistent with the well-known association between coarctation and bicuspid aortic valve.
Key takeaways
Aortic coarctation is associated with bicuspid aortic valve in a large proportion of cases. On lateral chest radiograph, the absence of the aortic arch posterior to the trachea is a subtle sign of coarctation because the small, medialized aorta is pulled out of view. Rib notching from enlarged intercostal collaterals is a classic but not always present finding. The three-sign may be visible on frontal projection at the coarctation site. CT with sagittal reconstruction is the definitive imaging modality for characterizing the degree of stenosis and collateral vessels.
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