Asymptomatic Aortic Coarctation Diagnosed Because of Large Abdominal Arterial Collateral

An active 29-year-old man was referred to our institution for a severe hypertension (170/100 mmHg) despite monotherapy with nicardipine. Physical examination documented symmetric blood pressure with a normal pulse examination. Transthoracic echocardiography showed normal left ventricular function without significant hypertrophy, a tricuspid aortic valve and a normal ascending aorta. He underwent an enhanced computed tomography angiography (CTA) to rule out renal artery stenosis or adrenal pathology (normal renal arteries; Panel A: asterisk). Three-dimensional CTA reconstructions revealed widespread abdominal arterial collaterals and a relatively small abdominal aorta (Panels A and B) measuring 17 mm. As the abdominal collateral arterial network appeared connected to thoracic arterial collateral and in particular the left epigastric artery (Panels A, B and C: arrows), we suspected an aortic coarctation (AC).