The aorta and its normal variants and abnormalities – a clinical case

Abstract

The aorta can be divided into a thoracic and abdominal part and has complex embryologic development. The thoracic aorta consists of four sections – the most proximal part is the aortic root. The tubular ascending aorta, aortic arch, and descending aorta are the next segments. The descending aorta has different morphologic variants and anomalies, which knowledge is of crucial importance for the clinician and the radiologist to avoid misdiagnosis. Ductus diverticulum, aortic spindle, and pseudocoarctation of the aorta are one of the most common variants. We present a clinical case of a 54-year-old male presented for chest pain provoked by exertion with a past medical history of poor control of arterial hypertension. The diagnostic imaging tests showed ectasia of the sinuses of Valsalva and ascending aorta, aortic spindle, and ductus diverticulum, which caused a differential diagnostic dilemma. The aortic isthmus may have three morphologic variants – with convex contours and uniform diameter, slight bulging and focal bulging known as ductus diverticulum. The latter represents a remnant from the completely or partially closed ductus arteriosus. The aortic spindle is a fusiform concentric bulging of the aorta with smooth contours, situated just distal to the isthmus. Aortic pseudocoarctation is an uncommon congenital vascular anomaly, which represents elongation and kinking of the descending thoracic aorta just distal to the ostium of the left subclavian artery.