Complete interruption of the aortic arch. 1. Characteristic radiographic findings in 21 patients.

Abstract

The radiographs of 21 patients with complete interruption of the aortic arch are reviewed, together with the literature, to emphasize characteristic radiographic features previously not recognized or discussed. In addition to the nonspecific radiologic findings of a left-to-right shunt through the invariably present ventricular septal defect, characteristic and unique features noted on chest radiograph and barium swallow that may suggest the diagnosis prior to catheterization include: a) a midline trachea; b) a hypoplastic ascending aorta with direct vertical ascent toward the neck; c) absence of the aortic "knob;" d) termination of the descending thoracic aortic shadow at the level of the main pulmonary artery; e) a "low arch" on lateral or left anterior oblique projections; and f) absence of the normal aortic impression on the barium-filled esophagus. Rib notching, when present, in association with the above findings indicates a stenotic or closed ductus arteriosus with collateral circulation through intercostal arteries to the descending aorta. The bilateral or unilateral location, right or left side, of the notching is dependent on the site of interruption and origin of the subelavian arteries and may permit differentiation into types and subtypes on chest radiograph.

Valoración radiológica y manejo quirúrgico de una interrupción del arco aórtico, a propósito de un caso

“…La radiografía simple de tórax generalmente no es una técnica específica, pero suele servir para guiar el diagnóstico. Un botón aórtico ausente y una cardiomegalia son hallazgos que podrían estar relacionados con una posible IAA 8 .…”

ACR Appropriateness Criteria® Nontraumatic Aortic Disease

“…In aortic coarctation, a chest radiograph may reveal a characteristic "figure 3" sign or rib notching [30,31]. Chest radiographs can also be useful in excluding other congenital aortic diseases, such as obstructive arch disease and vascular rings [32,33]. However, given the availability of better imaging technologies and radiography's lack of specificity [21,34,35], a more definitive evaluation is typically required for an accurate diagnosis.…”

Persistence of third aortic arch with fourth aortic arch agenesis.

“…11 This malformation is clearly not amenable to the usual direct approach to surgical repair of aortic interruption. 2 The calibre of the hypoplastic segment of the descending aorta seems to preclude its use in a primary repair necessitating an ascending aortic to abdominal descending aortic graft.…”