Delayed Diagnosis of Coarctation of the Aorta in a Hypertensive Child: Challenges in Early Detection

Area of Science:

• Pediatric Cardiology
• Hypertension Research
• Diagnostic Imaging

Background:

• Coarctation of the aorta (CoA) is a significant cause of secondary hypertension in children.
• Persistent, treatment-resistant hypertension in preadolescents often necessitates a broad differential diagnosis.

Observation:

• A case is presented of a preadolescent with resistant hypertension initially evaluated with normal echocardiograms and extensive workups.
• Crucially, lower extremity blood pressure and femoral pulse assessment were omitted during initial evaluations.
• Diminished femoral pulses were detected upon referral to pediatric cardiology, leading to further investigation.

Findings:

• A third echocardiogram revealed severe coarctation of the aorta (CoA), confirmed by CT angiography.
• Successful stent placement normalized blood pressure, allowing discontinuation of antihypertensive medications.

Implications:

• This case underscores diagnostic pitfalls from incomplete physical examinations and over-reliance on single imaging modalities.
• Reinforces the necessity of guideline-based pediatric hypertension evaluation, including femoral pulse and four-limb blood pressure assessment.
• Highlights the value of repeat or advanced imaging in persistent hypertension cases with high clinical suspicion to prevent diagnostic delays.