Tardus–parvus Doppler waveform in the renal arteries of an adult patient suggesting aortic coarctation

Abstract

A 19-year-old man presented with arterial hypertension without blood pressure difference between his upper and lower extremities. Duplex Doppler sonography was performed to rule out renal artery stenosis and revealed a tardus-parvus pattern in both renal arteries as well as in the abdominal aorta, whereas the left subclavian artery showed a normal waveform, suggesting a more distal obstruction. Aortography confirmed a severe aortic coarctation. Because the typical signs and symptoms of aortic coarctation may not be present, especially in adults, a tardus-parvus pattern in the abdominal aorta and its branches, contrasting with a normal pattern in the supra-aortic arteries, should suggest the diagnosis.

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

“…The second important aspect is concerning the diagnostic value of renal DU in detecting AC. The majority of sonologists introduced the dampened waveform pattern known as parvus-tardus [ 6 ]. This pattern mostly detected through on indirect assessment of arterial region located after stenosis (Fig.…”

“…Although suspicion of AC raises during routine physical examination by detecting Blood Pressure (BP) difference between arm and leg [ 1 ], AC can be presented during adulthood with isolated or resistant hypertension and without significant difference in BP between the upper and lower extremities [ 3 , 4 ]. Some of such patients are referring to nephrologists to evaluate their secondary hypertension [ 5 , 6 ].…”

Failing to palpate femoral pulses in adult hypertensive patients may lead to diagnostic wandering and major cerebrovascular events in cases of undetected aortic coarctation

“…The “ tardus-parvus ” pattern due to the presence of an upstream tight arterial stenosis consists of enhanced systolic rise-time (by >0.07 s), a decrease in peak systolic velocity, and low resistive indices related to downstream arteriolar vasodilation as an adaptation to the decrease in hemodynamic pressures. The existence of a “ tardus-parvus ” pattern in both renal arteries was previously reported to be due to the presence of an upstream AC in two boys (11- and 15 years of age) [ 2 ] and in one 19-year-old man [ 3 ], but such a pattern has to our knowledge not been reported for adult patients at the time of a major cardiovascular event. The combined results of Doppler ultrasound imaging on the abdominal and lower-limb arteries (below the diaphragm) and on the cephalic and upper-limb arteries (above the diaphragm) led to the suspicion of aortic stenosis, even though the origin of the patients’ clinical signs had remained unidentified since birth.…”

Bilateral Tardus‐Parvus Waveforms in a Patient With Aortic Coarctation

“…Aortic coarctation constitutes 5% to 10% of all congenital cardiac malformations and is most commonly located distal to the origin of the left subclavian artery (near the site of insertion of the ductus arteriosus). It can initially present in childhood with hypertension or may present in adulthood with isolated hypertension without typical differences in blood pressure (BP) between upper and lower limbs 1 , 2 . Such patients are sometimes evaluated for other causes of secondary hypertension, such as renovasular hypertension 3 .…”

“…Most of these patients are referred to a nephrologist to rule out secondary causes of hypertension. Mostly they are referred to undergo sonography to exclude renal artery stenosis 1 , 3 . Moreover, there is little need for kidney Doppler studies in patients presenting with differences in upper and lower limb BPs.…”