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[Coarctation of the aorta on the plain chest x-ray (author's transl)]
Insights
Plain chest X-rays can reliably diagnose coarctation of the aorta. Key signs include prominent left subclavian artery and collateral circulation, correlating well with operative findings.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Thoracic Surgery
Background:
- Coarctation of the aorta is a congenital narrowing of the aorta.
- Accurate diagnosis is crucial for timely intervention and management.
- Non-invasive imaging plays a vital role in preoperative assessment.
Purpose of the Study:
- To evaluate the diagnostic accuracy of plain chest X-rays for coarctation of the aorta.
- To correlate radiographic findings with angiography, hemodynamic pressures, and surgical outcomes.
- To identify reliable radiographic indicators of aortic coarctation.
Main Methods:
- Analysis of chest X-rays in 38 patients with confirmed coarctation of the aorta.
- Correlation of radiographic findings with angiography, hemodynamic data, and operative results.
- Assessment of specific signs: subclavian artery prominence, collateral circulation (rib notching, internal mammary artery), cardiac/aortic configuration changes.
Main Results:
- Prominent left subclavian artery observed in 33 cases; collateral circulation signs in 26 cases.
- Dilated subclavian artery and collateral circulation, with elevated pressures, were frequent combinations.
- Radiographic signs showed a very good correlation with operative findings; aortic constriction itself was an unreliable sign.
Conclusions:
- Plain chest X-rays are a reliable method for diagnosing coarctation of the aorta.
- Specific radiographic features, such as subclavian artery prominence and collateral circulation, are key diagnostic indicators.
- X-ray findings correlate well with surgical findings, supporting its use in diagnosis.
Abstract:
Chest X-rays were analysed in 22 male and 16 female patients (mean age 30.7 years) with coarctation of the aorta. The results were correlated with angiography, haemodynamic pressures and operative findings. The left subclavian artery was prominent in 33 cases, signs indicating a collateral circulation (rib notching, internal mammary artery) were present in 26 cases. In addition there were changes of cardiac and aortic configuration. The least reliable sign was constriction of the aorta due to the stenosis itself. Frequent combinations of X-ray signs were dilatation of the left subclavian artery and a collateral circulation, in addition to signs of increased pressure (n = 25). Less frequently (n = 8) only a dilated subclavian artery and signs of increased pressure were found. The prominence of the subclavian artery was particularly marked in systolic pressure gradients through the stenosis of greater than 40 mm Hg, and the formation of a collateral circulation when average aortic pressure differences above and below the stenosis were less than 40 mm Hg. Collaterals were to be found most frequently with a correlation of 2:1 of the systolic gradient to the mean pressure gradient delta Ps/delta Pm. A very good correlation existed comparing X-ray signs with findings at operation. The diagnosis of coarctation of the aorta can thus be made with sufficient certainty from the plain chest X-ray.