A computerized tomographic (CT) scan showed bilateral contusions of the lungs, a small residual pneumothorax, a pneumome-diastinum and a left-sided mediastinal hematoma with a possible aortic lesion at the level of the aortic isthmus
, just distal to the origin of the left subclavian artery in the CT slices (Fig.
(1,3) Most of these aortic injuries occur at or distal to the level of the ligamentum arteriosus (1) in the aortic isthmus
Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus
, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle.
Coarctation of the aorta (CoA) is defined as congenital narrowing of the aortic isthmus
near the ductus arteriosus or arterial ligament.