Incidental detection of late presenting co-arctation of the aorta on chest x-ray: the importance of rib notching

Subclavian artery injuries are complex and challenging due to anatomy and exposure during surgery. The surgical management depends on the mechanism of injury, the patient's haemodynamic stability and other injuries sustained. If control of bleeding is lost during surgery, it results in immediate exsanguination, with high mortality and morbidity rates. New techniques with endovascular surgery have changed the approach and outcome of these injuries. In this case report, an incidental finding of coarctation of the aorta in a 32-year-old man after sustaining a gunshot to the chest, with a subsequent subclavian artery injury is reported.

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“…Untreated, these patients have a high risk of death due to congestive heart failure, aortic rupture, and bacterial endocarditis. ( 8 )…”

Section: Discussionmentioning

confidence: 99%

Incidental aortic coarctation in traumatic subclavian artery injury

Merwe

Makhadi

Moeng

2021

Trauma Case Reports

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“…Aortic coarctation may be picked up incidentally on chest x-ray by the presence of inferior rib notching and the 'figure of three' sign, which is a result of post-stenotic dilation of the aorta as shown in figure 2. 16,17 These signs are subtle, and may be missed unless actively sought, as in this case. Transthoracic echocardiography can also be used to confirm aortic coarctation, and to identify associated structural cardiac abnormalities; CT or magnetic resonance angiography (MRA) are the investigations of choice, depending on local availability.…”

Section: Discussionmentioning

confidence: 86%

A rare cause of secondary hypertension

Dulai

Oshodi

2015

Acute Med

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Severe hypertension is a well-recognised cause for acute medical admission, and can have serious consequences if untreated. We present a 48 year old patient in whom coarctation of the aorta was identified following the finding of severe hypertension at the time of routine preoperative assessment, and subsequent finding of absent lower limb pulses. The patient had a past history of Apert syndrome, a rare autosomal dominant inherited condition characterised by craniosynostosis, facial dysmorphia, syndactyly of the hands and feet and cardiac abnormalities. This case report highlights the importance of a careful clinical examination in adults with severe hypertension, without which coarctation of the aorta may go undiagnosed.

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“…Survival with coarctation depends on the degree of the development of a collateral blood supply which originates from the subclavian arteries and supplies the descending aorta primarily via the intercostal, inferior epigastric and subscapular arteries [3]. However, it is poorly developed in newborns; however, it becomes increasingly robust as the patient ages.…”

Section: Figure 1: Ct Scan Showing a Narrowed Segment Of The Aorta: (mentioning

confidence: 99%

“…Coarctation of the aorta (CoA) is a congenital condition in which theaortais narrow, usually in the area where the ductus arteriosus inserts, just distal to the left subclavian artery.It is found in approximately 4% to 6% of all patients with congenital heart defects, with a 2:1 predominance in males [1,2]. Untreated CoA is uncommon in the fifth decade of life and is associated with 75% and 90% mortality by 46 and 58 years of age, respectively [1,3]. A patient with CoA may present with problems during cardiac or non-cardiac surgical procedures which could pose considerable challenges in their anaesthetic management.…”

Section: Introductionmentioning

confidence: 99%