Imaging
Coarctation of the Aorta
- Preliminary Diagnosis: Coarctation of the Aorta
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of coarctation of the aorta.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of coarctation of the aorta.
- VI. What are the contraindications for the alternative imaging techniques?
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
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