A 42 year old lady presents with mild exertional dyspnea and fatigue for several months.
Her medical and family histories are unremarkable and she is not on any drugs.
Her full blood count, liver and renal profiles and ESR are found to be normal.
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The ECG shows changes suggestive of left ventricular hypertrophy.
The aorta demonstrates a prominent figure of three sign. The ribs are notched bilaterally.
The blood flow in the descending aorta is turbulent and has a higher velocity than in the ascending aorta. Moderate left ventricular hypertrophy and diastolic dysfunction is present. No structural cardiac defects are noted. The ejection fraction is 58%.
MRA shows constriction of a 10 cm segment of the aorta, just distal to the left subclavian artery. Numerous collateral vessels connecting the upper and lower systemic circulations are noted.