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