Clinical Presentation

A hypertensive teenager with lower blood pressures in the lower extremities than in the upper extremities.

Frontal chest radiograph demonstrates ectasia of the ascending aorta and an enlarged aortic knob with a “notch” between the aortic knob and the proximal descending thoracic aorta (arrow). There is also mild rib notching, best seen in the posterior aspect of the left sixth rib (arrowhead).

Differential Diagnosis

• Coarctation of the aorta: The findings of a prominent ascending aorta, enlarged aortic knob, notch between the aortic knob and proximal descending thoracic aorta, and rib notching are highly suggestive of coarctation of the aorta.

• Aortic stenosis: