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+---
+title: "Narrowed Aorta"
+docid: "763503a4-a7b8-4aff-8846-3dfbe312125c"
+authors:
+  - key: "df804626-c042-4296-96e3-836a6da50fd6"
+    value: "Gregory Kicska, MD, PhD"
+breadcrumbs:
+  -
+    name: "Cardiac"
+    slug: "cardiac"
+    treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
+  -
+    name: "Differential Diagnosis"
+    slug: "differential-diagnosis"
+    treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
+  -
+    name: "Narrowed Aorta"
+    slug: "narrowed-aorta"
+    treeNodeId: null
+category: "Cardiac"
+documentVersionId: "d3c26ea4-8f08-4b3c-8e42-c5d40e18e83c"
+imageCount: 9
+lastUpdated: "03/17/22"
+pageDescription: "Narrowed Aorta"
+pageKeywords: "Cardiac, Differential Diagnosis, Narrowed Aorta"
+pageTitle: "Narrowed Aorta | STATdx"
+enhancedTitle: "Narrowed Aorta"
+type: "DDX"
+breadcrumbs:
+  - "Cardiac"
+  - "Differential Diagnosis"
+  - "Narrowed Aorta"
+---
+# ESSENTIAL INFORMATION
+
+- ## Key Differential Diagnosis Issues
+  
+  
+    - Focal outer diameter narrowed in coarctation or vasculitis
+    - Normative data should be consulted to exclude common pitfall of misinterpreting normal aortic dimension for small body as abnormal
+    - For > 45 years, aorta considered abnormally small if diameter at level of main pulmonary artery < 24 mm for ascending and < 18 mm for descending aorta
+          - Larger diameters may still be abnormal if older age, larger body surface area (BSA), or male patient
+    - Luminal diameter narrowing in atherosclerosis, aortic thrombus, and sarcoma
+- ## Helpful Clues for Common Diagnoses
+  
+  
+    - **Coarctation of Aorta**
+          - Focal narrowing occurs below ductus arterious in adults, at ductus arterious with arch hypoplasia in neonates
+          - Dilated collaterals (intercostal, internal thoracic) indicate hemodynamically significant coarctation
+          - Treated coarctation patients can have restenosis
+          - Associated with bicuspid aortic valve, Turner syndrome, Marfan syndrome
+    - **Pseudo-coarctation**
+          - Redundant aorta with narrowing distal to left subclavian origin without hemodynamic effect
+          - No rib notching, cardiomegaly, or collateral vessels
+          - Dilated brachiocephalic artery and high arch often present
+- ## Helpful Clues for Less Common Diagnoses
+  
+  
+    - **Corral Reef Aorta**
+          - "Rock hard" calcific atherosclerotic plaque protruding into lumen of abdominal aorta
+          - Bizarre shape of protrusions resemble corals
+    - **Leriche Syndrome**
+          - Aortoiliac occlusive disease due to severe atherosclerosis of distal abdominal aorta and ileo-femoral arteries
+          - Presenting symptom triad in chronic variant: Claudication, absent femoral pulses, erectile dysfunction
+    - **Large Vessel Vasculitis**
+          - Variable segment length narrowing
+          - Branch vessel narrowing is common
+          - Periaortic thickening and enhancement
+          - Periaortic FDG uptake implies active disease
+          - Patient < 40 years of age implies Takayasu, patient > 40 years of age implies giant cell arteritis
+- ## Helpful Clues for Rare Diagnoses
+  
+  
+    - **Extrinsic Aortic Compression**
+          - Retroperitoneal fibrosis, neurofibromatosis, sarcomas, other neoplasms
+    - **Aortic Sarcoma**
+          - Rare mesenchymal neoplasms arising from aortic tissue and may protrude into and narrow aortic lumen
+          - Angiosarcoma, leiomyosarcoma, fibrosarcoma, hemangioendothelioma, and myxoid sarcomas have been reported
+
+
+## Images
+
+
+### Selected Images
+
+![PA radiograph shows subtle areas of rib notching <img src='img/arrows/WS.png'/>. Note the rapid narrowing of the proximal descending thoracic aorta <img src='img/arrows/BC.png'/>, which then returns to normal size more distally <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_bc3bf664-51c7-420c-b430-4d6916a855f9_annotated_true_size_900_quality_90_f10d096da5fdf9b00bf048692c69fa28dff74204.jpg)
+**Coarctation of Aorta**
+*PA radiograph shows subtle areas of rib notching <img src='img/arrows/WS.png'/>. Note the rapid narrowing of the proximal descending thoracic aorta <img src='img/arrows/BC.png'/>, which then returns to normal size more distally <img src='img/arrows/WO.png'/>.*
+
+![PA radiograph shows subtle areas of rib notching <img src='img/arrows/WS.png'/>. Note the rapid narrowing of the proximal descending thoracic aorta <img src='img/arrows/BC.png'/>, which then returns to normal size more distally <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_bc3bf664-51c7-420c-b430-4d6916a855f9_size_174_quality_85_4e11019138a63194d4d8baaa68bd1c32c1963d6a.jpg)
+**Coarctation of Aorta**
+*PA radiograph shows subtle areas of rib notching <img src='img/arrows/WS.png'/>. Note the rapid narrowing of the proximal descending thoracic aorta <img src='img/arrows/BC.png'/>, which then returns to normal size more distally <img src='img/arrows/WO.png'/>.*
+
+![Sagittal multiplanar CT reformat in the same patient shows focal narrowing of the aorta distal to the ductus arteriosus <img src='img/arrows/WS.png'/>. Prominent collaterals were present (not shown).](images/app.statdx.com_image_thumbnail_206f362a-05a7-4e76-9d15-c093a0f3a0a4_annotated_true_size_900_quality_90_1696b8de6283b478789bcdab3c84897dd30953ec.jpg)
+**Coarctation of Aorta**
+*Sagittal multiplanar CT reformat in the same patient shows focal narrowing of the aorta distal to the ductus arteriosus <img src='img/arrows/WS.png'/>. Prominent collaterals were present (not shown).*
+
+![Sagittal oblique NECT shows focal mild narrowing of the aorta <img src='img/arrows/WO.png'/> in a patient with pseudo-coarctation. The aorta appears redundant. No collateral vessels were present.](images/app.statdx.com_image_thumbnail_d566eed0-181c-4347-a644-59636da7bb66_annotated_true_size_900_quality_90_f95e9e102c14f676ef0eaa39744aa24f52466060.jpg)
+**Pseudo-coarctation**
+*Sagittal oblique NECT shows focal mild narrowing of the aorta <img src='img/arrows/WO.png'/> in a patient with pseudo-coarctation. The aorta appears redundant. No collateral vessels were present.*
+
+![Axial CECT shows extrinsic compression of the aorta <img src='img/arrows/WO.png'/> by retroperitoneal soft tissue <img src='img/arrows/WS.png'/> in a patient with retroperitoneal fibrosis.](f5df5335-eda0-4a73-9e2c-af871b7816cd)
+**Extrinsic Aortic Compression**
+*Axial CECT shows extrinsic compression of the aorta <img src='img/arrows/WO.png'/> by retroperitoneal soft tissue <img src='img/arrows/WS.png'/> in a patient with retroperitoneal fibrosis.*
+
+![Coronal oblique contrast-enhanced MRA shows a diffusely narrowed aorta occlusion of the superior mesenteric artery <img src='img/arrows/WS.png'/>. Note reconstituted SMA <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_0f036a0c-50e4-44bd-8378-3fc76fd92930_annotated_true_size_900_quality_90_120ba3d8d20ccd90183034dabe24bbb30b844017.jpg)
+**Large Vessel Vasculitis**
+*Coronal oblique contrast-enhanced MRA shows a diffusely narrowed aorta occlusion of the superior mesenteric artery <img src='img/arrows/WS.png'/>. Note reconstituted SMA <img src='img/arrows/WO.png'/>.*
+
+![Sagittal oblique MIP MRA in a patient with Takayasu arteritis shows tapered narrowing of the mid-descending thoracic aorta <img src='img/arrows/WS.png'/>. Celiac artery origin stenosis is also present <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_a35e02ef-fd12-4e84-a9a6-387c4becbf24_annotated_true_size_900_quality_90_7c95f98abb06ba9b84928d15c79ddcf7e656c570.jpg)
+**Large Vessel Vasculitis**
+*Sagittal oblique MIP MRA in a patient with Takayasu arteritis shows tapered narrowing of the mid-descending thoracic aorta <img src='img/arrows/WS.png'/>. Celiac artery origin stenosis is also present <img src='img/arrows/WO.png'/>.*
+
+![Sagittal oblique MIP CECT shows tapered narrowing of the mid-descending aorta with wall thickening in a patient with Takayasu arteritis. Note the absence of atherosclerotic disease.](images/app.statdx.com_image_thumbnail_d54bd5ca-39ff-4f22-8732-412e1dd69d1e_annotated_true_size_900_quality_90_bff0aa5ef20a0cbdc557c8256fa7d14f9f3d401f.jpg)
+**Large Vessel Vasculitis**
+*Sagittal oblique MIP CECT shows tapered narrowing of the mid-descending aorta with wall thickening in a patient with Takayasu arteritis. Note the absence of atherosclerotic disease.*
+
+![Axial CECT shows a narrowed aorta with circumferential wall thickening <img src='img/arrows/WS.png'/>. Branch vessel stenoses were also present. This patient was &gt; 40 years of age and was diagnosed with giant cell arteritis.](images/app.statdx.com_image_thumbnail_15fcbefa-4bbe-4015-b011-399741152e1e_annotated_true_size_900_quality_90_060cc52f35a63df82a061d07d37842d2f83dfe7b.jpg)
+**Large Vessel Vasculitis**
+*Axial CECT shows a narrowed aorta with circumferential wall thickening <img src='img/arrows/WS.png'/>. Branch vessel stenoses were also present. This patient was &gt; 40 years of age and was diagnosed with giant cell arteritis.*
+
+
+### Additional Images
+
+![Coronal CECT shows tapered narrowing of the mid-descending thoracic aorta <img src='img/arrows/WS.png'/> in a patient with Takayasu arteritis.](images/app.statdx.com_image_thumbnail_42cf14d6-fb3e-4ccb-9144-a6dca1fdf92f_annotated_true_size_900_quality_90_07988c00ea232842f6dfbcf6900f58c01bc20193.jpg)
+**Large Vessel Vasculitis**
+*Coronal CECT shows tapered narrowing of the mid-descending thoracic aorta <img src='img/arrows/WS.png'/> in a patient with Takayasu arteritis.*
+