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Previous Volume 357:717-718 August 16, 2007 Number 7 Next

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The medical mystery in the June 21 issue¹ involved a 28-year-old woman with a 1-year history of high blood pressure that was diagnosed during her first pregnancy. In addition to an elevated blood pressure, at 200/100 mm Hg, in the left arm, physical examination revealed a grade 3/6 midsystolic murmur over the anterior part of the chest and back. Radiography of the chest showed classic changes associated with coarctation of the aorta, including notching of the ribs (Figure 1A, arrows) due to erosion by dilated collateral vessels and ectasia of the ascending aorta. Magnetic resonance imaging showed constriction of the lumen of the aorta distal to the origin of the left subclavian artery (Figure 1B, arrow). After endovascular repair with stent placement (Figure 1C, arrow), the patient's blood pressure normalized. After 1 year of follow-up, she continued to do well, with a blood pressure of 136/87 mm Hg while she was taking 10 mg of amlodipine daily.

View larger version (65K): [in this window] [in a new window]   Figure 1. Coarctation of the Aorta in a Young Woman. A chest radiograph shows changes associated with coarctation of the aorta (Panel A, arrows). Magnetic resonance imaging shows constriction of the lumen of the aorta (Panel B, arrow). A chest radiograph shows endovascular repair with stent placement (Panel C, arrow).

 

Raul Quiros-Lopez, M.D.
Javier Garcia-Alegria, M.D.
Costa del Sol Hospital
29600 Marbella, Spain
quiroslopez{at}hotmail.com

Editor's note: We received 2962 responses to this medical mystery — 65% from physicians in practice, 21% from physicians in training, 8% from medical students, and 6% from other readers. Eighty-three percent of the responses correctly identified the diagnosis of coarctation of the aorta. Responses were received from 92 countries.

References

1. Quiros-Lopez R, Garcia-Alegria J. A medical mystery -- high blood pressure. N Engl J Med 2007;356:2630-2630. [Free Full Text]

PDF PDA Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by Quiros-Lopez, R. PubMed Citation