---
title: "Narrowed Aorta"
docid: "763503a4-a7b8-4aff-8846-3dfbe312125c"
authors:
- key: "df804626-c042-4296-96e3-836a6da50fd6"
value: "Gregory Kicska, MD, PhD"
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name: "Cardiac"
slug: "cardiac"
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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name: "Differential Diagnosis"
slug: "differential-diagnosis"
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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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
. Note the rapid narrowing of the proximal descending thoracic aorta 
, which then returns to normal size more distally 
.](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 . Note the rapid narrowing of the proximal descending thoracic aorta , which then returns to normal size more distally .*
**Coarctation of Aorta**
*PA radiograph shows subtle areas of rib notching . Note the rapid narrowing of the proximal descending thoracic aorta , which then returns to normal size more distally .*
**Coarctation of Aorta**
*Sagittal multiplanar CT reformat in the same patient shows focal narrowing of the aorta distal to the ductus arteriosus . Prominent collaterals were present (not shown).*
**Pseudo-coarctation**
*Sagittal oblique NECT shows focal mild narrowing of the aorta in a patient with pseudo-coarctation. The aorta appears redundant. No collateral vessels were present.*
**Extrinsic Aortic Compression**
*Axial CECT shows extrinsic compression of the aorta by retroperitoneal soft tissue in a patient with retroperitoneal fibrosis.*
**Large Vessel Vasculitis**
*Coronal oblique contrast-enhanced MRA shows a diffusely narrowed aorta occlusion of the superior mesenteric artery . Note reconstituted SMA .*
**Large Vessel Vasculitis**
*Sagittal oblique MIP MRA in a patient with Takayasu arteritis shows tapered narrowing of the mid-descending thoracic aorta . Celiac artery origin stenosis is also present .*
**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.*
**Large Vessel Vasculitis**
*Axial CECT shows a narrowed aorta with circumferential wall thickening . Branch vessel stenoses were also present. This patient was > 40 years of age and was diagnosed with giant cell arteritis.*
### Additional Images
**Large Vessel Vasculitis**
*Coronal CECT shows tapered narrowing of the mid-descending thoracic aorta in a patient with Takayasu arteritis.*