A 16-year-old girl, on examination in the doctor's office, was found to have absent pulses in both femoral arteries. In addition, her blood pressure was higher in both upper limbs than in both lower limbs. An anteroposterior radiograph of the chest showed notching of the necks of the upper ribs on both sides. What is your diagnosis? Why is there notching of the ribs?

Question

Quizplus · Accepted Answer

The Answer is Coarctation of the aorta is a narrowing of the aorta just proximal, opposite, or distal to the site of attachment of the ligamentum arteriosum. It is believed to result from the presence of an unusual quantity of ductus arteriosus muscle tissue incorporated in the wall of the aorta.
When the ductus arteriosus contracts after birth, the ductus muscle in the aortic wall also contracts and the aortic lumen becomes narrowed. Later, fibrosis occurs and permanent narrowing takes place. The notching of the lower borders of the ribs is caused by the opening up
of the collateral circulation through the subclavian, internal thoracic, and posterior intercostal arteries to carry blood from above the coarctation to the distal part of the aorta ; it is the dilated posterior intercostal arteries that notch the ribs

A 16-Year-Old Girl, on Examination in the Doctor's Office, Was