129 lines
9.3 KiB
Markdown
129 lines
9.3 KiB
Markdown
---
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title: "Narrowed Aorta"
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docid: "763503a4-a7b8-4aff-8846-3dfbe312125c"
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authors:
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- key: "df804626-c042-4296-96e3-836a6da50fd6"
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value: "Gregory Kicska, MD, PhD"
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breadcrumbs:
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-
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name: "Cardiac"
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slug: "cardiac"
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treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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-
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name: "Narrowed Aorta"
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slug: "narrowed-aorta"
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treeNodeId: null
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category: "Cardiac"
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documentVersionId: "d3c26ea4-8f08-4b3c-8e42-c5d40e18e83c"
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imageCount: 9
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lastUpdated: "03/17/22"
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pageDescription: "Narrowed Aorta"
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pageKeywords: "Cardiac, Differential Diagnosis, Narrowed Aorta"
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pageTitle: "Narrowed Aorta | STATdx"
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enhancedTitle: "Narrowed Aorta"
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type: "DDX"
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breadcrumbs:
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- "Cardiac"
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- "Differential Diagnosis"
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- "Narrowed Aorta"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Focal outer diameter narrowed in coarctation or vasculitis
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- Normative data should be consulted to exclude common pitfall of misinterpreting normal aortic dimension for small body as abnormal
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- 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
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- Larger diameters may still be abnormal if older age, larger body surface area (BSA), or male patient
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- Luminal diameter narrowing in atherosclerosis, aortic thrombus, and sarcoma
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- ## Helpful Clues for Common Diagnoses
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- **Coarctation of Aorta**
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- Focal narrowing occurs below ductus arterious in adults, at ductus arterious with arch hypoplasia in neonates
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- Dilated collaterals (intercostal, internal thoracic) indicate hemodynamically significant coarctation
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- Treated coarctation patients can have restenosis
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- Associated with bicuspid aortic valve, Turner syndrome, Marfan syndrome
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- **Pseudo-coarctation**
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- Redundant aorta with narrowing distal to left subclavian origin without hemodynamic effect
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- No rib notching, cardiomegaly, or collateral vessels
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- Dilated brachiocephalic artery and high arch often present
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- ## Helpful Clues for Less Common Diagnoses
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- **Corral Reef Aorta**
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- "Rock hard" calcific atherosclerotic plaque protruding into lumen of abdominal aorta
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- Bizarre shape of protrusions resemble corals
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- **Leriche Syndrome**
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- Aortoiliac occlusive disease due to severe atherosclerosis of distal abdominal aorta and ileo-femoral arteries
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- Presenting symptom triad in chronic variant: Claudication, absent femoral pulses, erectile dysfunction
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- **Large Vessel Vasculitis**
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- Variable segment length narrowing
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- Branch vessel narrowing is common
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- Periaortic thickening and enhancement
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- Periaortic FDG uptake implies active disease
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- Patient < 40 years of age implies Takayasu, patient > 40 years of age implies giant cell arteritis
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- ## Helpful Clues for Rare Diagnoses
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- **Extrinsic Aortic Compression**
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- Retroperitoneal fibrosis, neurofibromatosis, sarcomas, other neoplasms
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- **Aortic Sarcoma**
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- Rare mesenchymal neoplasms arising from aortic tissue and may protrude into and narrow aortic lumen
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- Angiosarcoma, leiomyosarcoma, fibrosarcoma, hemangioendothelioma, and myxoid sarcomas have been reported
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## Images
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### Selected Images
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**Coarctation of Aorta**
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*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'/>.*
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**Coarctation of Aorta**
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*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'/>.*
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**Coarctation of Aorta**
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*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).*
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**Pseudo-coarctation**
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*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.*
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**Extrinsic Aortic Compression**
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*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.*
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**Large Vessel Vasculitis**
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*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'/>.*
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**Large Vessel Vasculitis**
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*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'/>.*
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**Large Vessel Vasculitis**
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*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.*
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**Large Vessel Vasculitis**
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*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 > 40 years of age and was diagnosed with giant cell arteritis.*
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### Additional Images
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**Large Vessel Vasculitis**
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*Coronal CECT shows tapered narrowing of the mid-descending thoracic aorta <img src='img/arrows/WS.png'/> in a patient with Takayasu arteritis.*
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