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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2701881110.5144/0256-4947.2016.28.3.1710asm-2-153ImagesPreviously undetected severe aortic coarctation in an adult: value of MRI Ajlan Amr Mohammad From the Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Dr. Amr Mohammad Hassan Abdulrazaq Ajlan, Department of Radiology, King Abdulaziz University, Jeddah, 21411, Saudi Arabia, T: 022-6408222 Ext. 18163, amrajlan@yahoo.comMar-Apr 2016 36 2 153 154 Copyright © 2016, Annals of Saudi Medicine2016This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A 39-year-old male presented with slowly progressive dyspnea, increasing fatigability, and no chest pain. Clinical examination revealed no signs of heart failure. The posteroanterior chest radiograph revealed cardiomegaly (arrows in Figure 1) and no features of pulmonary edema or obvious mediastinal abnormalities. A magnified view of the posterior ribs showed subtle bilateral inferior rib notching (arrows in Figure 2). A sagittal oblique 3-dimensional contrast-enhanced magnetic resonance image clearly showed severe focal post-ductal aortic coarctation (circle in Figure 3). In addition, marked internal mammary (blue arrow in Figure 3) and intercostal (red arrows in Figure 3) arteries are present, consistent with a hemodynamically significant lesion. This example highlights the utility of magnetic resonance imaging (MRI) in radiation-free non-invasive evaluation of adults with congenital aortic abnormalities. Specific sequences in MRI, such as velocity-encoded phase contrast imaging, may add clinically important hemodynamic information by estimating flow volumes and pressure gradients.

Figure 1 Posteroanterior chest radiograph revealing cardiomegaly.

Figure 2 Magnified view of the posterior ribs.

Figure 3 Marked internal mammary and intercostal arteries.