A 73 y.o. woman presents with abdominal pain

What is wrong with her aorta?

A hint is in the picture below

Our patient had a coral reef aorta.  Coral reef aorta is described as rock-hard calcifications in the aorta above the renal arteries.  (most vascular occlusive disease is below the renal arteries)  The calcifications grow into the aorta and make stenting very difficult. This is a rare problem with a frequency of 6 in 1000 patients.

The first description of coral reef aorta was by the biographer of a Swiss anatomist Johann Jakob Wepfer in the 1600’s.  During Wepfer’s autopsy it was noted that he had semicircular projections into the lumen of the upper aorta similar to bone. Risk factors for coral reef aorta include RA and long-term use of steroids.  It has been reported to cause embolic disease and even cardiogenic shock by occluding the aortic outflow.

Our patient had mesenteric ischemia and died of shock liver. She was noted to have occlusion of the celiac artery, with hepatic ,and renal infarcts and active contrast extravasation from a branch of the pancreaticoduodenal artery with necrosis of the pancreas.

Grotemeyer D, Pourhassan S, Rehbein H, et al. The coral reef aorta—a single centre experience in 70 patients.  2007 Int J Angiol. Autumn 16(3):98-105.

Kopani K, Liao S, Shaffer K.  The coral reef aorta: diagnosis and treatment following CT. 2009 Radiol Case Rep;4(1):209.

Dinis da Gama A, Pedro L, et al. A new method of ostial revascularization of digestive and renal arteries in complex