Coarctation of the aorta (CoA) is a rare cause of secondary high blood pressure (HBP); its diagnosis is important, since it is a potentially treatable etiology of HBP. CoA accounts for 6%-8% of all congenital heart disease, occurring as aortic arch stenosis proximal to the insertion of ductus arteriosus, below the origin of the left subclavian artery. (1, 2) CoA can occur as a solitary lesion, but is often associated with other cardiovascular lesions, including bicuspid aortic valve, aortic arch hypoplasia, mitral valve abnormalities, and ventricular and atrial septal defects. (1, 2) This is the case of a 39-year-old female patient with a history of HBP refractory to medical treatment, multiple therapy schemes with metoprolol, enalapril, valsartan, and hydrochlorothiazide, associated to recurrent headaches and coldness of the lower limbs; chest X-ray showed bilateral "notches" on the lower costal margins, or Roesler's sign (Figure 1). Cardiac Doppler ultrasound showed bicuspid aortic valve, normal left ventricular size and wall thickness, and preserved systolic function; cardiac CT-angiography of the chest revealed coarctation of the descending aorta posterior to the origin of the left subclavian artery, with prominent pulmonary arteries (Figure 2A).
Pseudoaneurisma de válvula mitral secundario a Declaración de conflicto de interesesLos autores declaran que no poseen conflicto de intereses.(Véanse formularios de conflicto de intereses de los autores en la web/ Material suplementario).
Brachial artery pseudoaneurysms are rare but can be associated with severe complications as ischemia of the upper extremity. We report a case of a brachial artery pseudoaneurysm in the crease of the elbow presenting as a pulsating mass with progressive growth over the past year. The ipsilateral hand was sightly cold and presented paresthesia. The lesion was due to inadvertent arterial puncture during venipuncture. The pseudoaneurysm was successfully treated with surgical resection and vascular reconstruction with a brachial to ulnar artery bypass and brachial to radial artery bypass with saphenous vein graft. The different therapeutic options available for brachial artery pseudoaneurysms are discussed, considering the anatomic characteristics and patients’ symptoms.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.