Interrupted aortic arch: A misdiagnosed cause of hypertension

We present the case of a 47-year-old man with hypertension for over 20 years, referred to our hospital due to mild aortic dilatation detected on a transthoracic echocardiogram. On physical examination weak lower limb pulses and a blood pressure differential of >50 mmHg between arms and legs were...

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Bibliographic Details
Published in:Revista portuguesa de cardiologia 2014-06, Vol.33 (6), p.389.e1-389.e5
Main Authors: Ponte, Marta, Dias, Adelaide, Dias Ferreira, Nuno, Fonseca, Conceição, Mota, João Carlos, Gama, Vasco
Format: Article
Language:English
Subjects:
Aorta, Thoracic - abnormalities
Aortic coarctation
Aortic Coarctation - complications
Aortic Coarctation - diagnosis
Coartação da aorta
Diagnostic Errors
Hipertensão
Humans
Hypertension
Hypertension - etiology
Interrupted aortic arch
Interrupção do arco aórtico
Male
Middle Aged
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Summary:We present the case of a 47-year-old man with hypertension for over 20 years, referred to our hospital due to mild aortic dilatation detected on a transthoracic echocardiogram. On physical examination weak lower limb pulses and a blood pressure differential of >50 mmHg between arms and legs were detected. Complete interruption of the aortic arch below the left subclavian artery was diagnosed by computed tomography angiography. With this case we aim to draw attention to aortic coarctation and interrupted aortic arch as potential causes of hypertension and to highlight the importance of the physical examination in the diagnosis of secondary causes of hypertension. Apresentamos o caso de um homem de 47 anos, com hipertensão arterial desde há mais de 20 anos, referenciado ao nosso hospital por dilatação ligeira da aorta ascendente detetada em ecocardiograma transtorácico. No exame físico constatou-se que os pulsos femorais eram pouco amplos e existia um diferencial de pressões superior a 50 mmHg entre os membros superiores e inferiores. Por angiotomografia computorizada do tórax diagnosticou-se uma interrupção completa do arco aórtico abaixo da artéria subclávia esquerda. Com este caso pretendemos relembrar a coartação da aorta e interrupção do arco aórtico como potenciais causas de hipertensão e realçar a importância do exame físico no diagnóstico de causas secundárias de hipertensão.
ISSN:0870-2551
2174-2030
DOI:10.1016/j.repc.2014.01.014