Bifurcated Abdominal Aorta, with a Coarctation over the Right Branch of the Bifurcated Abdominal Aorta and Aberrant Renal Arteries Originating from the Left Branch of the Bifurcated Abdominal Aorta

Persistent double dorsal aorta in patient with cavernous sinus thrombosis: A case report

Persistent double dorsal aorta is a rare congenital anomaly of the descending aorta in which the descending aorta is divided into 2 lumens below the ligamentum arteriosum. There are only a few cases reported to date. A 52-year-old female presented with right ptosis since 2 months prior. Neurological examination was significant for cavernous sinus syndrome in the right eye. Digital subtraction angiography revealed right cavernous sinus thrombosis and an incidental finding of double lumen descending aorta, with separation of the second lumen at the level of the thoracic aorta. Computed tomography angiography confirmed a type 2 persistent double dorsal aorta. Persistent double dorsal aorta consists of 2 types. Type 1 is the complete separation of the 2 descending aorta and type 2 is the double lumen descending aorta separated by a dividing septum. Multiplanar 3D reconstruction Computed tomography angiography or magnetic resonance angiography is important to differentiate between this anomaly and acquired conditions such as aortic dissection. In persistent double dorsal aorta, both lumens constitute the true lumen, and branch into the visceral arteries before ending up as the right and left common iliac arteries, respectively, while in aortic dissection, one is a false lumen and does not give a branch to visceral vessels. Persistent double dorsal aorta is a rare congenital anomaly of descending aorta which manifests as 2 separate aorta or 2 lumens of aorta separated by a dividing septum. Knowledge of this anomaly is paramount for interventional neuroradiologists to distinguish it from acquired lesions.

Duplicated Descending Aorta Resulting in Early Localized Vascular Disease

While congenital variants of the aortic arch have been well described, anatomic anomalies of the descending aorta are extremely rare. We present a case of a 31-year-old male with congenital duplication of the descending aorta resulting in advanced localized atherosclerotic disease found incidentally on diagnostic imaging. This case presents a rare anatomic variant that can not only lead to early aortic disease but may also complicate future endovascular intervention.

HISTOLOGIC AND MORPHOLOGIC CHARACTER OF PEDIATRIC ABDOMINAL AORTIC DEVELOPMENTAL COARCTATION AND HYPOPLASIA

OBJECTIVES

Abdominal aortic coarctation and hypoplasia are uncommon diseases, recognized most often in pediatric-aged individuals. Comprehensive studies regarding the pathologic spectrum of these aortopathies are nonexistent. This investigation was undertaken to better define the histologic and morphologic character of abdominal aortic narrowings affecting children and assess its potential relevance to contemporary clinical practice.

METHODS

Aortic specimens obtained during open operations in children being treated for symptomatic, noninflammatory abdominal aortic narrowings at the University of Michigan were subjected to histologic study following hematoxylin-eosin, Movat, Verhoeff Van Gieson, and Masson's trichrome preparations. Microscopic findings were correlated with the anatomic aortic images. In addition, a detailed review was completed of all prior reports in the English literature that included images depicting the histologic character of noninflammatory abdominal aortic narrowings in children.

RESULTS

Among a series of 67 pediatric-aged individuals undergoing open surgical interventions for abdominal aortic narrowings, eight children ranging in age from 9 months to 18 years, had adequate aortic tissue available for study. The loci of the specimens paralleled the anatomic sites of segmental coarctations observed in the entire series, with involvement of the suprarenal abdominal aorta (3), intrarenal aorta (2), and infrarenal aorta (1). Diffusely hypoplastic abdominal aortas (2) included one case of a de facto aortic duplication, represented by a channel that paralleled the narrow native aorta and gave origin to celiac artery branches, as well as the superior mesenteric and renal arteries. Concentric or eccentric intimal fibroplasia was observed in every aorta, often with internal elastic fragmentation and duplication (4). Media abnormalities included elastic tissue disorganization (3), and focal medial fibrosis (1). Organizing luminal thrombus occurred in two infants. Coexistent ostial stenoses of the celiac, superior mesenteric, or renal arteries were observed in all but the only child who having an infrarenal aortic coarctation. Neurofibromatosis-1 affected one child whose histologic findings were indistinguishable from those of the other children. Review of prior published histologic images of abdominal aortic coarctation and hypoplasia affecting children from other centers revealed a total of 14 separate reports, each limited to single case photomicrographs of which 11 exhibited intimal fibroplasia.

CONCLUSIONS

Intimal fibroplasia is a common accompaniment of developmental abdominal aortic coarctation and hypoplasia. It is posited that intimal fibroplasia, that is likely progressive in instances of abnormal shear stresses in these diminutive vessels, may contribute to less salutary outcomes following endovascular and certain open reconstructions of pediatric abdominal aortic narrowings.

Unusual congenital aortic anomaly with rare common celiamesenteric trunk variation: MR angiography and digital substraction angiography findings

Magnetic resonance angiography and digital substraction angiography (DSA) findings in a case with a rare congenital thoracoabdominal aortic hypoplasia and common celiamesenteric trunk variation with occlusion of infrarenal abdominal aorta are described here. To our knowledge, this aortic anomaly has not been previously described in the English literature. DSA is the optimum imaging modality for determination of aortic hypoplasia, associated vascular malformations, collateral vessels, and direction of flow within vessels.