A case of asymptomatic high-grade aortic coarctation

A 20-year-old woman with a diagnosis of thyroid carcinoma underwent preoperative staging. A computed tomographic scan of the chest showed a coarctation (CA) of the descending aorta. The patient reported a history of borderline hypertension and no symptoms at rest and on agonistic sport activity. At examination, she had a regular pulse with 70 beats/min. No cardiac murmurs were found. Electrocardiography and bidimensional echocardiography did not show pathological findings. A three-dimensional reconstruction of the aorta by multislice computed tomography (MSCT) documented a high-grade postductal aortic coarctation, distal to the origin of left subclavian artery (panels A and B). It affected a long tract of descending thoracic aorta. MSTC also showed an extensive collateral circulation from bilateral internal thoracic arteries (ITAs) to internal epigastric arteries (IEAs) (panels A and B). The development of a wide collateral circulation which supplied blood flow distally to the aortic coarctation led to an asymptomatic clinical status even on agonistic sport activity and delayed the diagnosis. The patient was scheduled for surgery on the basis of the anatomical characteristics of the aortic coarctation and underwent surgical repair with graft interposition 1 month after thyroidectomy.