 Hello everyone, this is Dr. Mang Shivastra. We are to the department of radio diagnosis from Jawaharlal Nehru Medical College, Aligarh Muslim University. Today I am presenting the role of renal Doppler in diagnosis of co-op patient of Avota, a case report. Renal Doppler is indicated in hypertension, especially if there is significant suspicion of renal vascular hypertension, suspected vascular pathology like aneurysm, pseudoaneurysm, malformation or AV fistula, vascular murmur in epigastium or to identify the cause of renal failure in patient at risk of renal vascular disease. Herein we are presenting a child who was diagnosed with co-optation of Avota using renal Doppler during workup for secondary hypertension. Now introduction, co-optation of Avota accounts for nearly 5-8% of all congenital heart defects. It is more common in male and male is to female ratio is 2 to 3 is to 1. It can be associated with other congenital anomalies like bicuspid valve, which is the most common association, which is seen in 75-80% cases. VST, TGA, Parachute-Mittal valve, Petenductis-RTOS, Belly aneurysm, Spinalis scoliosis. There is also syndromic association for example, Sean syndrome, Face syndrome, Ternum syndrome, etc. The diagnosis of co-optation of Avota can be delayed and can be present only when there is serious complications such as congestive heart failure, which is seen usually in infants or hypertension, which is commonly seen in older children. On clinical examination, it is suspected whenever there is discrepancy between arm and leg systemic blood pressure or hypertension raised into medical treatment. Because of its high efficacy for detection of secondary hypertension, renal Doppler is simply being paid attention to. Herein, we presented a 15-year-old male with secondary hypertension who was finally diagnosed to be caused by co-optation of Avota using renal Doppler sonography. Co-optation of Avota can be primarily divided into two types. The infantile, which is also called as pre-ductal form, which is characterized by diffuse hypotasia or narrowing of the Avota just distilled to the brachiochiphalate, proximal to the ductus arteosis. And the second one is adult type, which is also called as juxtaductal, post-ductal or middle aortic type, which is characterized by a short segment abrupt stenosis of post-ductal Avota. Now, the case history. A 15-year-old male, patient presented with complaint of occipital headache on and off for three months. There is no family history of known this factor for hypertension. On general examination, patient was found to be hypertensive and BP measured in upper limb was 170 by 100. The systemic examination appears unremarkable, no cardiac murmur or bruise was detected. The lab investigation were with a normal limit and patient was advised renal Doppler to screen for secondary cause of renal hypertension, that is renal aortic stenosis. On renal Doppler, the bilateral male renal arteries and intra-renal arteries shows increased acceleration time, spectral broadening and perverse stardust flow. There was reduced monophagic flow in abdominal Avota by lateral lower limb arteries. However, upper limb arteries shows normal multiphasic flow. On the basis of these findings, proximal flow limiting pathology, likely in Avota is suspected and CT angiography was advised. On C2 angiography, a focal constrictive narrowing in the descending thoracic Avota is noted, distal to the origin of left sub-clebian artery with proximal dilatation of ascending thoracic Avota and distal normal appearing descending thoracic Avota. Also noted, multiple dilated perivartibral and mediashtinal colactals enhanced motting pre and post stenotic segment. Now the final diagnosis, the patient was diagnosed as a case of co-optation of Avota post ductile type and referred to higher center for further management on patient's request. Now the discussion. Many experts believe that the suspicion of stenosis in Avota raised during Doppler ultrasound is more reliable sign for possible co-optation of Avota than basic physical examination. Considerable differences in flow characteristics is in the descending Avota is a major hallmark in those patients having co-optation of Avota. However, it should be kept in mind that in some patients normal flow velocities are recorded in spite of existence of clinical sign of co-optation of Avota and in fact the findings of normal flow velocities does not exclude the presence of an obstructive lesion. Now the conclusion. The main differential diagnosis for co-optation of Avota is bilateral renal RT stenosis. The main color Doppler findings which favors co-optation of Avota is started as far as flow in bilateral renal RTs and segmental RTs sought with pattern wave in abdominal Avota and normal flow pattern in upper limb RTs. Reinal Doppler is a non-invasive affordable and cost effective skinning pool in detection of congenital RTs and normalities and general workup for secondary hypertension. So it should be recommended as a part of general workup before proceeding to CT and geography. These are the references. Thank you.