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Peer-reviewedCC BYEuropean heart journal. Case reports

Coral reef aorta demonstrated by serial computed tomography: a case report.

  • Tsuneaki Kawashima1
  • Masaki Harada1
  1. 1Department of Cardiology, Tango Central Hospital, 158-1 Sugitani, Mineyama-cho, Kyotango, Kyoto 627-8555, Japan.
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Abstract

Background

Coral reef aorta (CRA) is a rare vascular disorder characterized by dense, protruding calcified plaques within the abdominal aorta, often resulting in ischaemic symptoms. Because of its rarity and atypical presentation, CRA is frequently diagnosed at an advanced stage.Case summary

A 50-year-old male smoker with hypertension and hyperlipidaemia presented with progressive lower extremity symptoms. Four years before presentation, he developed bilateral lower limb numbness and was diagnosed with lumbar disc herniation, which likely masked the underlying vascular disease. One year before presentation, he developed intermittent claudication after ∼10 min of walking, followed by severe bilateral rest pain 1 month before presentation. The ankle-brachial index (ABI) was markedly reduced to 0.49 bilaterally. Computed tomography (CT) revealed extensive calcified plaques causing near occlusion of the infrarenal abdominal aorta. Serial CT over 6 years demonstrated progressive intraluminal calcification, facilitating diagnosis and treatment planning. Open aortic graft replacement with inferior mesenteric artery reconstruction was performed. Postoperatively, symptoms resolved completely, and the ABI improved to 1.13 (right) and 1.19 (left). At 1-year follow-up, the patient remained asymptomatic with the ABI of 1.07 bilaterally, and CT confirmed graft patency.Discussion

This case highlights the importance of considering CRA in patients with lower limb ischaemia, particularly when symptoms are initially attributed to non-vascular conditions. Serial CT is essential for detecting progression and enabling timely diagnosis. Open surgical intervention remains the most reliable treatment and can achieve excellent clinical outcomes in advanced disease.

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Cite

BibTeXRIS
BibTeX
@article{kawashima2026coral,
  title = {{Coral reef aorta demonstrated by serial computed tomography: a case report.}},
  author = {Tsuneaki Kawashima and Masaki Harada},
  journal = {European heart journal. Case reports},
  year = {2026},
  month = oct,
  doi = {10.1093/ehjcr/ytag732},
  url = {https://europepmc.org/article/MED/42923753},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Coral reef aorta demonstrated by serial computed tomography: a case report.
AU  - Tsuneaki Kawashima
AU  - Masaki Harada
PY  - 2026
DA  - 2026/10/03
JO  - European heart journal. Case reports
DO  - 10.1093/ehjcr/ytag732
UR  - https://europepmc.org/article/MED/42923753
AB  - Background  Coral reef aorta (CRA) is a rare vascular disorder characterized by dense, protruding calcified plaques within the abdominal aorta, often resulting in ischaemic symptoms. Because of its rarity and atypical presentation, CRA is frequently diagnosed at an advanced stage.Case summary  A 50-year-old male smoker with hypertension and hyperlipidaemia presented with progressive lower extremity symptoms. Four years before presentation, he developed bilateral lower limb numbness and was diagnosed with lumbar disc herniation, which likely masked the underlying vascular disease. One year before presentation, he developed intermittent claudication after ∼10 min of walking, followed by severe bilateral rest pain 1 month before presentation. The ankle-brachial index (ABI) was markedly reduced to 0.49 bilaterally. Computed tomography (CT) revealed extensive calcified plaques causing near occlusion of the infrarenal abdominal aorta. Serial CT over 6 years demonstrated progressive intraluminal calcification, facilitating diagnosis and treatment planning. Open aortic graft replacement with inferior mesenteric artery reconstruction was performed. Postoperatively, symptoms resolved completely, and the ABI improved to 1.13 (right) and 1.19 (left). At 1-year follow-up, the patient remained asymptomatic with the ABI of 1.07 bilaterally, and CT confirmed graft patency.Discussion  This case highlights the importance of considering CRA in patients with lower limb ischaemia, particularly when symptoms are initially attributed to non-vascular conditions. Serial CT is essential for detecting progression and enabling timely diagnosis. Open surgical intervention remains the most reliable treatment and can achieve excellent clinical outcomes in advanced disease.
SN  - 2514-2119
ER  -