Asymptomatic aortic coarctation diagnosed because of a vast calcified collateral circulation

摘要

A 62-year-old man came to the emergency department reporting mild chest pain that was similar to pain he had experienced 18 years before when he suffered a myocardial infarction. An electrocardiogram and cardiac biomarkers did not show any signs of an acute coronary syndrome; he was therefore admitted to the cardiology department for further studies. A chest X-ray revealed two round structures that were initially interpreted as calcified nodules (Panel A). Stress echocardiography was undertaken, which demonstrated no evidence of myocardial ischemia but did indicate a coarcta-tion of the distal aortic isthmus with a peak to peak gradient of 8 rnmHg. To confirm this finding, computed tomographic angiography (CTA; Panel B) and magnetic resonance angiog-raphy (MRA; Panel C) were done, showing a significant aortic coarctation.