Figure 4d. Midaortic dysplastic syndrome in an 18-year-old man with hypertension and weak femoral pulses. (a) Lateral volume-rendered image depicts calcification and stenosis of the thoracoabdominal aorta (large arrow). The area of stenosis includes the ostium of the celiac trunk and superior mesenteric artery (small arrows). (b) Frontal volume-rendered image shows stenoses of the aorta (large arrow) and of the right and left renal arteries (small arrows). Note the meandering mesenteric artery (arrowhead). (c) Contrast-enhanced axial CT section depicts thrombosis and calcification of the retrocrural aorta (large arrow) and enlarged epigastric (small arrows) and intercostal (arrowheads) arteries. (d) Contrast-enhanced axial CT section shows collateral circulation in the anterior abdominal wall (arrows) and the meandering mesenteric artery (arrowhead). Note the hypoplastic abdominal aorta. (e) Frontal volume-rendered image of the anterior thoracoabdominal wall shows enlarged internal mammary arteries (large arrows) that communicate with the epigastric arteries (small arrows).