Differential Diagnosis for Tortuous Aorta on CXR

Single Most Likely Diagnosis

• Atherosclerotic disease: This is the most common cause of a tortuous aorta, especially in older adults, due to the buildup of plaque in the aortic wall, leading to its dilation and tortuosity.

Other Likely Diagnoses

• Hypertension: Chronic high blood pressure can cause the aorta to become tortuous over time due to the increased pressure on the aortic wall.
• Age-related changes: As people age, the aorta can naturally become more tortuous due to the loss of elasticity in the aortic wall.
• Aortic aneurysm: An aneurysm, which is a bulge in the aortic wall, can cause the aorta to appear tortuous on a chest X-ray (CXR).

Do Not Miss Diagnoses

• Aortic dissection: Although less common, an aortic dissection is a life-threatening condition where the inner layer of the aorta tears, causing blood to flow between the layers of the aorta. It requires immediate medical attention.
• Takayasu arteritis: A large vessel vasculitis that can cause inflammation and subsequent tortuosity of the aorta. It is more common in younger women and can lead to serious complications if not treated.

Rare Diagnoses

• Marfan syndrome: A genetic disorder that affects the body's connective tissue, including the aorta, leading to its dilation and tortuosity.
• Ehlers-Danlos syndrome: Another genetic disorder that can affect the connective tissue in the aorta, causing it to become tortuous.
• Congenital aortic anomalies: Certain congenital conditions, such as aortic coarctation or interruption, can cause the aorta to appear tortuous on imaging.