Kinking of the Aortic Arch (Pseudocoarctation)

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Abstract
This rare and peculiar anomaly of the aortic arch has not been widely recognized by either the clinician or radiologist. Approximately 50 cases have been reported in the literature. This series includes 8 patients with kinking of the aortic arch. The characteristic deformity was first noted on routine chest roentgenograms and was proved by forward or retrograde aortograms in all 8 patients. The systolic pressure gradient across the kinked thoracic aorta, as determined by intra-arterial catheter and/or blood pressure readings in the upper and lower extremities with sphygmomanometer, was usually less than 10 mm Hg. A pulse lag was not detected between the radial and femoral artery in any patient. Right heart catheterization was performed in 6 of the 8 patients and was normal with respect to pressures, cardiac output, and absence of intracardiac shunt. Surgical resection of the dilated aortic segments was performed in 2 of the patients. The aorta was so ectatic that surgical resection with an end-to-end anastomosis was performed with ease in both patients. The narrowed segment was larger than anticipated in both patients, and there was no evidence of collateral circulation or pressure gradient across the narrowed segment. One patient died 3 days postoperatively. Because it is a benign and asymptomatic anomaly that usually requires no treatment, it behooves the clinician and radiologist to become cognizant of its presence in the differential diagnosis of left superior mediastinal lesions in an effort to avoid needless thoracotomy.

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