Clinical Case 053: thoracic tortuosity

OK.  This is just plain out there.  We see some unusual stuff in the remote areas – things you only read about in the books!  I am going to put this in the category of medical voyeurism.  This is not how we should go about our business, but I had to share these pics!

20 yo with pleuritic chest pain, not much else, but hypertensive BP =  160/90 [not that unusual up here in the tropics]

He managed to get a D-dimer… and then the inevitable CT angiogram  (probably PERC negative)

Here is a slice from the CT –

OK – spot diagnosis, what is going on?


  1. Coarctation of the aorta?

  2. Coarctation of the aorta; rib notching and dilated tortuous arteries.

  3. Aortic coarctation?

  4. coderiferous says

    Coarct? CXR would likely have rib notching.

  5. Casey Parker says

    Nice work to you all.
    Yep, it is a nice picture of all he collateral vessels around a coarctation.
    This chap was an incidental diagnosis.
    Love he remote areas – you see all sorts of things which would probably have never made it past the Paeds team in a bigger city.
    And yes – he did have a big drop in BP from the right to left arms

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