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Joseph Junewick, MD FACR
over 5 years ago
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Aortic Coarctation - Diagnosis by Renal Artery Doppler

Case Detail

Anatomy: Vascular-Lymphatic
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US MR
Activities:
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History

14 year old female with hypertension presents for renal artery Doppler.


Case Images


Diagnosis

Aortic Coarctation

Findings

US – Images from renal artery Doppler examination show parvus tardus waveforms in both renal arteries but also the suprarenal abdominal aorta.

MR – subsequently 2D and 3D images confirm aortic coarctation and compensatory enlargement of internal mammary and paraspinal collateral vessles.

Discussion

Normal spectral waveforms of the aorta and renal arteries show sharp antegrade acceleration during systole followed by rapid deceleration during diastole. Waveforms beyond a stenosis show dampening of velocities with delayed peak; vascular compliance/impedance, cardiac output, vessel diameter and tortuosity can also affect waveforms distal to the stenosis. In this case, since parvus tardus waveforms were present in the abdominal aorta and renal arteries, a stenosis proximal to the abdominal aorta must be present and differential considerations are limited to include aortic valve stenosis, congenital aortic coarctation, middle aortic syndrome, and less likely Tayayasu arteritis, neurofibromatosis and tuberous sclerosis.

Reference

Stein MW, Koeninsberg M, Grigoropoulos J, et al. Aortic coarctation diagnosed in a hypertensive child undergoing Doppler sonography for suspected renal artery stenosis. Pediatr Radiol (2002); 32:384-386.



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