Case presentation
A 23-year-old male patient was admitted to the cardiology outpatient
clinic to investigate the aetiology of hypertension. His medical and
family history was unremarkable. In the physical examination of the
patient, the blood pressure taken from the left arm was 164/96 mmHg, the
blood pressure taken from the right arm was 161/92 mmHg, and there was
no difference in blood pressure between the lower and upper extremities.
Peripheral pulses were bilaterally palpable, radio-femoral, radio-radial
delay was not observed. Electrocardiogram was in normal sinus rhythm.
Pathological findings in transthoracic echocardiography were bicuspid
aortic valve (type 2, NCC+RCC fusion) and in the suprasternal evaluation
of descending aorta, peak systolic gradient was measured as 20 mm Hg in
doppler evaluation (Figure 1A-B). Buckling of the aorta was
seen on the patient’s chest x-ray (Figure 1C). CT angiography
was performed for the preliminary diagnosis of aortic coarctation, and
it was observed that the distal aortic arch had king formation at the
level of the isthmus, and the diameter of the narrowest part was
measured as 13*11 mm (Figure 2 -Video 1). In addition, it was
obtained that collateral circulation, which is the typical finding of
coarctation on CT angiography, did not develop in this patient. A peak
20 mm Hg systolic gradient qas observed between the pre and post
psedocoarctation segment in the catheterization study performed on the
patient for aortic pressure study. In the light of these clinical and
imaging findings, the patient was evaluated as aortic pseudocoarctation.