statdx/docs_md/articles/narrowed-aorta_763503a4-a7b8-4aff-8846-3dfbe312125c.md

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Narrowed Aorta	763503a4-a7b8-4aff-8846-3dfbe312125c	key value df804626-c042-4296-96e3-836a6da50fd6 Gregory Kicska, MD, PhD	name slug treeNodeId Cardiac cardiac fa90100b-619c-430e-8074-b5b9789bab39 name slug treeNodeId Differential Diagnosis differential-diagnosis 952326a0-b3ea-4a21-aa7a-d796cc9325ed name slug treeNodeId Narrowed Aorta narrowed-aorta null	Cardiac	d3c26ea4-8f08-4b3c-8e42-c5d40e18e83c	9	03/17/22	Narrowed Aorta	Cardiac, Differential Diagnosis, Narrowed Aorta	Narrowed Aorta | STATdx	Narrowed Aorta	DDX	Cardiac Differential Diagnosis Narrowed Aorta

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title: "Narrowed Aorta" docid: "763503a4-a7b8-4aff-8846-3dfbe312125c" authors:

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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

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.