Abstract
We reported a case of a 53-year-old patient with coarctation of aorta
and multiple aneurysmatic changes on aortic arch. Enhanced CT and
reconstruction revealed significant coarctation and multiple
aneurysmatic dilatation. The patient underwent stent implantation and
was discharged with symptoms relived. Follow-up examination progression
of aneurysms, however, without symptoms.
A 53-year-old woman presented to the department of cardiovascular
surgery with palpitation and dyspnea for one month. A 4-year history of
recurrent dizziness was found through interrogation. Blood pressure of
her limbs showed significant differences, her left upper limb blood
pressure, similar as both lower limbs, were obviously lower than in
normal, while blood pressure of right upper limb was about 155/85 mmHg,
which was higher than in normal.
Vertical plane image of enhanced-contrast CT demonstrated coarctation of
descending aorta and several aneurysmatic dilatation (Figure 1).
Three‐dimensional reconstruction of the computed tomography imaging
showed multiple aneurysmatic dilatation on both the proximal of the left
subclavian artery and the aortic arch. The diameter of the largest
saccular aneurysm was 2.6cm, and a small aneurysmal sac was at the back
side (Figure 2, panel A~C ).
In patients with coarctation of aorta, the blood pressure of the lower
extremities is relatively lower than the upper extremities. The patient
had a pressure difference greater than 20 mm Hg between the upper
extremities[1], indicating a combination of a left subclavian artery
aneurysm. Coarctation of aorta combined with subclavian artery aneurysm
was found in about 2% of patients[2], and the formation of
aneurysmatic changes may due to the hemodynamic effect of the narrowing
aorta. In this case, a stent was inserted to dilatate the coarctation
and the patient was discharged uneventfully. The re-examination was
carried out 7 years later, though patient remained asymptomatic,
reconstruction demonstrated a larger aneurysm of aortic arch with the
diameter of 4.6cm, while the left subclavian artery aneurysm remained
the same (Figure 2, panel D~F ).