Imaging

Coarctation of the Aorta

Preliminary Diagnosis: Coarctation of the Aorta

I. What imaging technique is first-line for this diagnosis?

  • Chest radiograph

II. Describe the advantages and disadvantages of this technique for diagnosis of coarctation of the aorta.

Advantages

  • Cheap examination that is quick and simple to perform

Disadvantages

  • It is a screening examination and findings may be nonspecific.

  • A "negative" chest radiograph does not exclude the diagnosis.

III. What are the contraindications for the first-line imaging technique?

  • No significant contraindications exist.

IV. What alternative imaging techniques are available?

  • MR angiography

  • Echocardiography

  • CT angiography

  • Angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of coarctation of the aorta.

MR angiography

Advantages

  • A systolic flow jet may be demonstrated and may be able to estimate pressure gradients.

  • Can visualize the coarctation and collateral vessels

Disadvantages

  • Long examination time

  • Relatively high cost

Echocardiography

Advantages

  • Can demonstrate the relationship wtih a patent ductus arteriosus

  • Can estimate the gradient across the narrowing

Disadvantage

  • Less-ideal imaging in adults

CT angiography

Advantages

  • Multiplanar reformatted images can demonstrate the coarctation and collaterals.

  • May also reval associated bicuspid aortic valve and aortic aneurysm

Disadvantages

  • Exposure to ionization radiation

  • Contrast material may harm the kidneys.

Angiography

Advantages

  • Directly measures the pressure gradient across the coarctatio

  • May treat during procedure with balloon angioplasty and stenting

Disadvantages

  • Invasive procedure with a risk of a procedural complication

  • Contrast material may harm the kidneys.

VI. What are the contraindications for the alternative imaging techniques?

MR angiography

  • Certain metallic devices, such as pacemakers and aneurysm clips, are not MR compatible

  • Renal failure due to the risk of nephrogenic systemic fibrosis

  • Pregnancy during the first trimester may be a relative contraindication.

Echocardiography

No significant contraindications exist.

CT angiography

  • Renal failure due to the risk of contrast-induced nephropathy

  • Allergy to contrast material may be a relative contraindication.

  • Pregnancy

Angiography

  • Renal failure due to the risk of contrast-induced nephropathy

  • Allergy to contrast material may be a relative contraindication.

  • Pregnancy

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