Coarctation of the aorta: The Daily PANCE Blueprint
A CXR demonstrates notching of the posterior portion of the 3rd to 8th ribs and abnormal contouring of the aortic arch (looks like a “3”). What is the most likely diagnosis?
A. Pneumomediastinum
B. Giant cell arteritis
C. Aortic mural thrombus
D. Coarctation of the aorta
E. Aortic dissection
Answer and topic summary
The answer is D. Coarctation of the aorta
Coarctation of the aorta (CoA) is a congenital condition defined by narrowing the descending aorta, leading to left ventricular pressure overload. Diagnosis is often delayed as many patients are initially asymptomatic. Clinical features include chest pain, cold extremities, and claudication with exertion. On exam, you may notice reduced SBP in the lower extremities (compared to bilateral UE). Initial tests include EKG, CXR, and echocardiography. Clasically on CXR you may see notching of the posterior one-third of the 3rd – 8th ribs (from erosion by collateral arteries). Additionally, abnormal contour of the aortic arch may produce the “3” sign. Corrective intervention is indicated based on certain criteria / guidelines by the AHA and ACC.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Pediatric EOR topic list
