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Cardiac » Cardiovascular
Coarctation of the aorta
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Author(s) :
S. Manohar, MD, DMRD
Presentation An 8 year old boy with abdominal pain and vomiting was referred for ultrasound of the abdomen.
Caption: Spectral waveform analysis of abdominal aorta
Description: The spectral tracing shows a dampened monophasic spectrum with nearly continuous flow.
Caption: Spectral tracing of the left renal artery at hilum
Description: A parvus tardus waveform is note with delayed time to peak velocity.
Caption: Spectral waveform of the right renal artery at hilum
Description: The right renal artery also shows a parvus tardus waveform with delayed time to peak velocity.
Caption: Suprasternal notch view of the arch
Description: Marked turbulence in flow color is noted in this image. Also a marked decrease in the caliber of the descending aorta is apparent.
Caption: Spectral waveform analysis of the descending aorta
Description: Marked increase in flow velocity -about 324 cm/sec is noted in the descending aorta at the ductus level.
Differential Diagnosis Juxtaductal coarctation of aorta

Final Diagnosis Juxtaductal coarctation of aorta.
Discussion Coarctation of the aorta is a narrowing of the aorta that occurs as a result of persistent muscular tissue in the region of the ligamentum arteriosus. Coarctation most commonly occurs opposite the ductus arteriosus, after the origin of the left subclavian artery and is called juxta-ductal coarctation. Coarctation is a cause of secondary hypertension, resulting in differential pressures in the upper and lower extremities.   

Take home point from this case: This case illustrates the importance of looking for a more proximal stenosis when abnormal bilateral renal artery waveforms and abnormal aortic waveform are noted.

In the case demonstrated here, tardus -parvus waveform is seen in the renal arteries bilaterally and suggests that a stenosis proximal to the point being studied may be present. The parvus tardus waveform of the renal artery is characterized by a slow rise of peak velocity distal to the stenosis, prolonged acceleration time and reduction of ipsilateral resistive index. The supra-renal aorta showed a monophasic and dampened flow due to low flow velocities, further suggesting that a more proximal narrowing should be ruled out. Gray scale and Doppler supra-sternal notch view of the aortic arch confirmed the presence of juxta-ductal coarctation.
Case References 1. Stein MW, Koenigsberg M, Grigoropoulos J, Cohen BC, Issenberg H. Aortic coarctation diagnosed in a hypertensive child undergoing Doppler sonography for suspected renal artery stenosis. Pediatr Radiol. 2002 May; 32(5):384-6. Epub 2002 Feb 27.
2. Amoroso A, Cianci R, Mander A, Faraglia V, Manfredini P, Clemenzia G. Indirect diagnosis of aortic coarctation by Doppler color echography. Velocimetric and spectral aspects in one of our cases. Minerva Cardioangiol. 1997 Oct; 45(10):509-14.
3. Conkbayir I, Yanik B, Keyik B, Edguer T, Hekimoglu B. Bilateral parvus-tardus Doppler waveform in renal arteries suggests aortic coarctation: case report. Can Assoc Radiol J. 2004 Feb; 55(1):45-7.
4. Richardson D, et al.  Parvus tardus waveform suggesting renal artery stenosis—remember the more proximal stenosis. Nephrol Dial Transplant (2000) 15: 539-543.
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