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
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