THE MIDDLE AORTIC SYNDROME

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Abstract
A clinico-pathological study has been made of 16 cases of inflammatory disease of the aorta in which the middle portion of the vessel (between the arch and bifurcation) is involved. In almost all the patients the disease produced constriction in the aorta and a specific symptom-complex which we designate as the "middle aortic syndrome." The disease is seen in children and young adults, predominantly affecting the female sex who presented with symptoms of hypertensive disease or lower limb claudication or abdominal angina. Most of them were diagnosed as having congenital coarctation, a condition to which there was a superficial resemblance. The suspicion of the unusual nature of the disease was usually aroused by the presence of a weak pulse in one or other superior extremity, and a low-placed systolic murmur over the dorsum or abdomen. On aortography a localized irregularity with constriction was seen in the mid-thoracic region in most of the cases and in the abdominal portion in some; occasionally, diffuse involvement with calcific changes was seen. Aneurysmal dilatations were seen in a few instances. Histological examination of the aorta showed a non-specific aortitis, probably of allergic origin. An associated tuberculous focus elsewhere (lung, liver, lymph nodes) in 75% of these cases suggested tubercle bacillus as a possible allergen. Surgical bypass procedures have been employed successfully in relieving the symptoms.