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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