A 22-year-old woman is incidentally found to have blood pressure 168/102 mmHg in the right arm and 96/60 mmHg in the left leg. A systolic ejection murmur is heard over the left sternal border radiating to the back. Chest X-ray shows rib notching. What is the most likely diagnosis?
- A Renal artery stenosis
- B Takayasu arteritis
- C Preductal coarctation of the aorta ✓
- D Atherosclerotic aortic disease
Correct answer: C. Preductal coarctation of the aorta
Explanation
Preductal coarctation of the aorta classically presents with hypertension in the upper extremities and hypotension in the lower extremities, radio-femoral delay, a systolic murmur radiating to the back, and rib notching on chest X-ray due to enlarged collateral intercostal arteries. It is a congenital cause of secondary hypertension often associated with Turner syndrome. Renovascular hypertension lacks the limb blood pressure differential. Takayaru arteritis affects the aorta and its branches but does not produce this classic pressure gradient.
Reference: Braunwald's Heart Disease, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.