The Use of Systematic Clinical Approach in Diagnosing Rare Cases of Secondary Hypertension: A Case Report of Mid Aortic Syndrome in a Young Patient

Abstract

Mid aortic syndrome (MAS) is a rare disease that occurs in children and young adults. The most important clinical feature reflecting vascular involvement is the presence of systemic hypertension. The diagnosis is usually made during the imaging assessment of secondary hypertension when routine echocardiography fails to identify the characteristic morphological or Doppler flow patterns associated with thoracic arch coarctation in the presence of the clinical features of aortic vascular obstruction. In this report, we present a case of a 22-year-old male who presented with systemic hypertension not responding to medical treatment, and whose systematic diagnostic workup revealed the diagnosis of MAS involving both renal arteries.

Keywords: fibromuscular dysplasia; giant cell arteritis; mid aortic; retroperitoneal fibrosis; takayasu arteritis.

Figure 1. CTA image 1

The image shows the narrowing of abdominal aorta distal to celiac artery and superior mesenteric artery and proximal to the inferior mesenteric artery (black arrows), and the internal thoracic artery-inferior epigastric artery collateral is one of the collaterals supplying blood flow to the lower extremity CTA: computed tomography angiography

Figure 2. CTA image 2

The image showing ostial narrowing of the renal artery CTA: computed tomography angiography