Coarctation of the Aorta

Preliminary Diagnosis: Coarctation of the Aorta

I. What imaging technique is first-line for this diagnosis?

• Chest radiograph

II. Describe the advantages and disadvantages of this technique for diagnosis of coarctation of the aorta.

Advantages

• Cheap examination that is quick and simple to perform

Disadvantages

• It is a screening examination and findings may be nonspecific.

• A "negative" chest radiograph does not exclude the diagnosis.

III. What are the contraindications for the first-line imaging technique?

• No significant contraindications exist.

IV. What alternative imaging techniques are available?

• MR angiography

• Echocardiography

• CT angiography

• Angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of coarctation of the aorta.

MR angiography

Advantages

• A systolic flow jet may be demonstrated and may be able to estimate pressure gradients.

• Can visualize the coarctation and collateral vessels

Disadvantages

• Long examination time

• Relatively high cost

Echocardiography

Advantages

• Can demonstrate the relationship wtih a patent ductus arteriosus

• Can estimate the gradient across the narrowing

Disadvantage

• Less-ideal imaging in adults

CT angiography

Advantages

• Multiplanar reformatted images can demonstrate the coarctation and collaterals.

• May also reval associated bicuspid aortic valve and aortic aneurysm

Disadvantages

• Exposure to ionization radiation

• Contrast material may harm the kidneys.

Angiography

Advantages

• Directly measures the pressure gradient across the coarctatio

• May treat during procedure with balloon angioplasty and stenting

Disadvantages

• Invasive procedure with a risk of a procedural complication

• Contrast material may harm the kidneys.

VI. What are the contraindications for the alternative imaging techniques?

MR angiography

• Certain metallic devices, such as pacemakers and aneurysm clips, are not MR compatible

• Renal failure due to the risk of nephrogenic systemic fibrosis

• Pregnancy during the first trimester may be a relative contraindication.

Echocardiography

No significant contraindications exist.

CT angiography

• Renal failure due to the risk of contrast-induced nephropathy

• Allergy to contrast material may be a relative contraindication.

• Pregnancy

Angiography

• Renal failure due to the risk of contrast-induced nephropathy

• Allergy to contrast material may be a relative contraindication.

• Pregnancy