case_images: PMC11055641_01
case_images: Poster anterior (PA) chest radiograph of the patient showing bilateral irregularities in the inferior aspect of the ribs suggestive of inferior rib notching (blue arrow) and absence of the aortic knuckle (orange arrow).
case_images: CRIRA2024-8691643.001.jpg
case_images: PMC11055641_01_CRIRA2024-8691643.001.jpg
case_images: fig1
case_images: On further examination of the osseous structures in the chest, there were multiple subtle irregularities involving the bilateral inferior ribs suggestive of inferior rib notching (Figure 1).
case_images: Axial postcontrast CT scan images at the level of the upper thoracic cavity, showing multiple tortuously enlarged collateral vessels in the chest wall and mediastinum.
case_images: CRIRA2024-8691643.002.jpg
case_images: PMC11055641_01_CRIRA2024-8691643.002.jpg
case_images: fig2
case_images: The patient was subsequently investigated with a computed tomography angiography (CT-A) which showed large collateral vessels all over the chest wall with tortuously dilated internal mammary arteries, posterior and anterior intercostal arteries, and large paravertebral and parascapular collateral vessels (Figure 2).
case_images: Sagittal reconstructed image of the CT angiography showing a complete discontinuity between the aortic arch and the descending thoracic aorta (arrow).
case_images: CRIRA2024-8691643.003.jpg
case_images: PMC11055641_01_CRIRA2024-8691643.003.jpg
case_images: fig3
case_images: (a) 3D volume rendered images showing a complete discontinuity between the aortic arch and the descending thoracic aorta (blue arrow). (b) 3D volume rendered images of the collateral vessels seen in the thoracic wall (green arrow) connecting to the postatretic segment (orange arrow).
case_images: CRIRA2024-8691643.004.jpg
case_images: PMC11055641_01_CRIRA2024-8691643.004.jpg
case_images: fig4
case_images: A interrupted aortic arch. A reconstruction in 3D of the defect vividly displays the distinct outline of the aorta interruption, with only collateral vessels supplying flow to the distal segment (Figure 4).