Mid-Aortic Syndrome Presenting With Unusual Stenoses

Abstract

We report on the case of a 13-year-old female presenting with dizziness and nausea related to high blood pressure. A complete medical evaluation revealed that the patient had middle-aortic syndrome (MAS), in which there was a severe stenosis of the abdominal aorta that affected her renal and visceral arteries. If left untreated, this syndrome may lead to serious complications such as renal insufficiency or congestive heart failure. Therefore, the decision was made to perform a thoracoabdominal surgery with surgical patch augmentation. The patient had successful postoperative recovery. We have reported this case to draw attention to the coarctation of abdominal aorta, a condition which should be considered in pediatric patients with hypertension, and to emphasize a successful treatment approach for MAS.

Sonographic findings in mid-aortic syndrome

“…3,4 While intra-arterial angiography of the aorta was previously the gold standard diagnostic test for MAS, CT angiography and MR angiography are now more widely used for evaluation and can define the extent of disease and guide surgical or endovascular management. 4,12 Radiation exposure from CT and safety issues of gadolinium in MRI are, however, important considerations particularly because MAS most commonly affects children and young adults, many of whom can have impaired renal function. 4 Surprisingly, there have been very few case reports documenting the sonographic features of MAS, particularly given that abdominal ultrasound is frequently used as a first-line investigation assessing for secondary causes of hypertension in these patients.…”

“…Often, however, endovascular or surgical treatment is required in patients with refractory hypertension and diminished renal function. 3,[12][13][14][15] CONCLUSION Mid-aortic syndrome has traditionally been investigated with CT, MR and conventional angiography and imaging findings have been well-defined. However, MAS most commonly affects young patients who typically present with severe arterial hypertension and in whom ultrasound is often the first imaging modality requested.…”