Preliminary Diagnosis: Coarctation of the Aorta
I. What imaging technique is first-line for this diagnosis?
- Chest radiograph
II. Describe the advantages and disadvantages of this technique for diagnosis of coarctation of the aorta.
Advantages
- Cheap examination that is quick and simple to perform
Disadvantages
- It is a screening examination and findings may be nonspecific.
- A “negative” chest radiograph does not exclude the diagnosis.
III. What are the contraindications for the first-line imaging technique?
- No significant contraindications exist.
IV. What alternative imaging techniques are available?
- MR angiography
- Echocardiography
- CT angiography
- Angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of coarctation of the aorta.
MR angiography
Advantages
- A systolic flow jet may be demonstrated and may be able to estimate pressure gradients.
- Can visualize the coarctation and collateral vessels
Disadvantages
- Long examination time
- Relatively high cost
Echocardiography
Advantages
- Can demonstrate the relationship wtih a patent ductus arteriosus
- Can estimate the gradient across the narrowing
Disadvantage
- Less-ideal imaging in adults
CT angiography
Advantages
- Multiplanar reformatted images can demonstrate the coarctation and collaterals.
- May also reval associated bicuspid aortic valve and aortic aneurysm
Disadvantages
- Exposure to ionization radiation
- Contrast material may harm the kidneys.
Angiography
Advantages
- Directly measures the pressure gradient across the coarctatio
- May treat during procedure with balloon angioplasty and stenting
Disadvantages
- Invasive procedure with a risk of a procedural complication
- Contrast material may harm the kidneys.
VI. What are the contraindications for the alternative imaging techniques?
MR angiography
- Certain metallic devices, such as pacemakers and aneurysm clips, are not MR compatible
- Renal failure due to the risk of nephrogenic systemic fibrosis
- Pregnancy during the first trimester may be a relative contraindication.
Echocardiography
No significant contraindications exist.
CT angiography
- Renal failure due to the risk of contrast-induced nephropathy
- Allergy to contrast material may be a relative contraindication.
- Pregnancy
Angiography
- Renal failure due to the risk of contrast-induced nephropathy
- Allergy to contrast material may be a relative contraindication.
- Pregnancy
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
