Imaging and Diagnosis
With imaging, resorption of the lower part of the ribs may be seen, due to increased blood flow over the neurovascular bundle that runs there. Post-stenotic dilation of the aorta results in a classic 'figure 3 sign' on x-ray. The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the aortic wall at the site of cervical rib obstruction, with consequent post-stenotic dilation. This physiology results in the '3' image for which the sign is named. When the esophagus is filled with barium, a reverse 3 or E sign is often seen and represents a mirror image of the areas of prestenotic and poststenotic dilatation.
Coarctation of the aorta can be accurately diagnosed with magnetic resonance angiography. In teenagers and adults echocardiograms may not be conclusive. In adults with untreated coarctation blood often reaches the lower body through collaterals, e.g. internal thoracic arteries via. the subclavian arteries. Those can be seen on MR, CT or angiography. An untreated coarctation may also result in hypertrophy of the left ventricle.
A case of coarctation of the aorta was published in the New England Journal of Medicine in 2007 employing chest radiography and magnetic resonance images.
A case of long-standing misdiagnosed coarctation of the aorta in an adult was described in the New York Times Magazine.
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