Coarctation diagnosis from renal ultrasound

Richard Brindley, Ultrasound, New Cross Hospital, The Royal Wolverhampton NHS Trust

An inpatient was referred to ultrasound from the paediatric consultant, regarding hypertension in a young female patient. The clinical question, pertaining to any evidence suggesting possible renal artery stenosis, that may account for the patients symptoms. There was no mention of any other underlying pathologies.

These are not always well demonstrated on ultrasound for numerous reasons, such as bowel gas, 2 renal arteries, patient body habitus etc.

I scanned the patient as normal assessing renal size and outline. I managed to demonstrate good perfusion on colour Doppler, however the renal arteries showed unusual dampened waveforms bilaterally. In light of the fact that the kidneys appeared otherwise normal was in doubt that this would represent bilateral renal artery stenosis in a young patient.

I decide to look at the femoral arteries, which also demonstrated an unusual dampened waveform.

I further assessed the radial arteries bilaterally to see if the was any proximal changes. These demonstrated normal waveforms.

I was concerned at this point and discussed the findings with a Consultant vascular radiologist. Who suggested this may represent a proximal aortic problem, either coarctation or possible proximal aortic narrowing.

The patient went on to have a chest x-ray which showed features of possible aortic coarctation; the reversed 3 sign and subtle rib notching. The patient was referred to a specialist centre for further cardiac assessment, where they confirmed severe aortic coarctation with small transverse arch and LV hypertrophy.

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