Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern

Abstract

Background: Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg.

Utility of Renal Artery Duplex Ultrasound for Screening and Diagnosis of Coarctation of the Aorta in Adults

“…The most common finding that raises suspicion for COA during a renal DUS is a low resistive, monophasic Doppler spectral waveform with a prolonged systolic upstroke in the abdominal aorta and bilateral renal arteries, which is suggestive of proximal aortic stenosis. [10][11][12][13][14][15] While echocardiography is a common imaging modality used in the identification of aortic coarctation, it failed to detect COA in our case. Knowledge of proper Doppler waveform interpretation and vascular anatomy was key in detecting an abnormality and getting the patient the proper diagnosis and care needed.…”

“…16 Nevertheless, the diagnosis of COA using renal DUS has been described in many case reports and case series in the literature, with patient's ages ranging from infancy to adulthood. [10][11][12][13][14][15] Most of those cases had the diagnosis of COA confirmed by echocardiography, CTA, or contrast aortography.…”

“…9 While computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are frequently used for diagnosing COA, cases of COA diagnosed by using renal artery DUS have been described in literature. [10][11][12][13][14][15] Most of those cases described the finding of bilateral renal artery parvus tardus flow patterns, consisting of a small amplitude waveform with a prolonged systolic rise, indicative of a proximal arterial stenosis. The current recommendation is for alternative imaging of the aorta and main branch vessels when bilateral renal artery parvus tardus waveforms are noted.…”

A Case of Coarctation of the Aorta Diagnosed by Tardus-Parvus Renal Doppler Flow Patterns

“…To differentiate between COA and bilateral renal artery stenosis, the pulse wave of the aorta should be checked, which is superior to the renal artery. If the aortic pulse wave also shows tardus-parvus patterns, it can either be COA or AS [ 1 ]. Additionally, engorged collateral circulations, such as in the internal thoracic artery, intercostal artery, or superior epigastric artery, can help in the diagnosis of COA [ 2 ].…”

Bilateral Tardus‐Parvus Waveforms in a Patient With Aortic Coarctation

“…Physical examination typically reveals substantial differences in the systolic BP between the upper and lower extremities (>10 mm Hg). Diastolic BPs are not usually affected 6 . Simultaneous palpation of the brachial and femoral pulses reveals delayed arrival of the femoral pulse.…”