Coarctation of aorta in an adult-a case report

Transcription

1 Coarctation of aorta in an adult-a case report Poster No.: P-0057 Congress: ESTI 2014 Type: Educational Poster Authors: R. Challa, R. Ahmed; Bolton/UK Keywords: Imaging sequences, CT, Thorax, Congenital DOI: /esti2014/P-0057 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Learning objectives To familiarise the reader with the imaging features of coarctation of aorta in an adult. Background Coarctation of aorta is a congenital malformation and typically a disease of childhood and early adulthood.without correction the mean life expectancy in patients who have not undergone correction is 35 years and 90% of untreated patients die before reaching the age of 50 years. It accounts for 5-10% of congenital heart disease.it is usually diagnosed during childhood by routine examination of blood pressure and femoral pulse palpation but may go undetected well until adulthood with only hypertension as a marker of its presence because the clinical signs can be subtle. We describe the case of a 42 yrs old man who was diagnosed with coarctation of aorta after found to have an abnormal CXR in a chest clinic. Imaging findings OR Procedure details A 42 year old male was referred to a chest physician by GP after found to have an abnormal CXR with right paratracheal opacity.he initially presented to GP with six month history of weight loss and night sweats,which have settled after a course of antibiotics for cellulitis in the thigh. His past medical history include mild asthma on salbutamol inhalers. No known hypertension. He has normal exercise tolerance with no cardiac symptoms. On examination his BP was normal, 140/65 mm of Hg. Bloods including U & E'S,LFT's,bone profile and inflammatory markers are normal. Hb 12.2 gm/dl. Page 2 of 10

3 FEV1 2.8L-66% predicted FVC 5.4 L-103% predicted FEV1/FVC-ratio 52% ECHO-showed dilated aortic root with mild aortic regurgitation and good LV function. CXR-showed right paratracheal opacity with no obvious rib notching. His CT scan of the thorax and abdomen with IV contrast showed coarctation of the aorta distal to the left subclavian artery with enlarged posterior intercoastal arteries in the thorax and internal mammary arteries. The right paratracheal opacity was due to dilated posterior intercoastal collaterals in the right paravertebral position. Patient subsequently was reviewed by a cardiologist and has been referred to Cardiothoracic surgeon for further management. Images for this section: Page 3 of 10

4 Fig. 1: CXR showing right paratracheal opacity Page 4 of 10

5 Fig. 7: Axial contrast enhanced image showing the enlarged right posterior intercoastal artery which is the cause of right paratracheal opacity seen on CXR Page 5 of 10

6 Fig. 5: Axial contrast enhanced CT showing the coarctation of descending thoracic aorta Page 6 of 10

7 Fig. 4: Sagittal reformat showing the coarctation of aorta distal to left subclavian artery origin Page 7 of 10

8 Fig. 6: Left lateral Volume Rendering(VR) showing coarctation of the aorta with associated enlarged internal mammary and posterior intercoastal arteries Page 8 of 10

9 Conclusion Coarctation of aorta is typically diagnosed in early life with childhood hypertension,lower extremity fatigue or weakness,diminished lower extremity pulses and/ or congestive cardiac failure. Our case illustrates that coarctation of aorta is a congenital cardiac malformation which can go undiagnosed until into adult age. This case also is unique as it is diagnosed after an abnormal CXR as aortic coarctation presenting during adult life generally present with hypertension. It is important for the radiologist to be familiar with the imaging features of coarcation of aorta on CT. References MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3D images. AJR,182(2004) Lee EY1, Siegel MJ, Hildebolt CF, Gutierrez FR, Bhalla S, Fallah JH. Coarctation of the aorta in adults. J Cardiovasc Surg 1997;28:124-7 Westaby S, Parnell B, Pridie RB. Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients.int J Cardiovascular Imaging,21 (2005)pp Goo HW1, Park IS, Ko JK, Kim YH, Seo DM, Park JJ J Med Life 2011 May 15;4(2): Epub 2011 May 25. Coarctation of the aorta in adults: what is the best treatment? Case report and literature review. Page 9 of 10

10 Jurcut R1, Daraban AM, Lorber A, Deleanu D, Amzulescu MS, Zara C, Popescu BA, Ginghina C. Diagn Interv Radiol 2009;15: Coarctation of the aorta in adults:preoperative evaluation with multidetector CT angiography Aysel Turkvatan,Pinar Ozdemir Akdur,Tulay Olcer,Turhan Cumhur Personal Information Page 10 of 10