Primary coarctation-related isthmus aneurysm in an adult

A 56-year-old female patient was transferred due to the presence of a left supraclavicular pulsatile mass. Further work-up was performed to confirm diagnosis. Angiography and computed tomography were also performed. The anatomy of the thoracic aorta suggested an unknown and untreated aortic coarctation. A second aortic narrowing was identified at the aortic arch, a result of elongation of the aorta. Endovascular approach was not possible, due to complexity of the aortic anatomy, and tortuosity. Open surgical repair was successfully performed. A primary coarctation-related isthmus aneurysm is an exceptional finding in adults, and is a life-threatening condition when diagnosis is delayed. Management and treatment are controversial and challenging.