A 19-year-old man is evaluated for recurrent frontal headaches and leg fatigue on running. Right arm BP is 168/102 mmHg. Femoral pulses are weak and delayed relative to the radial pulse. Chest radiograph shows inferior rib notching. The most likely cause of his hypertension is:
- A Coarctation of the aorta ✓
- B Pheochromocytoma
- C Primary hyperaldosteronism
- D Takayasu arteritis
Correct answer: A. Coarctation of the aorta
Explanation
Upper extremity hypertension with weak, delayed femoral pulses and collateral-dependent rib notching on radiograph is classic for aortic coarctation, where the obstruction lies distal to the left subclavian artery origin. Pheochromocytoma and primary aldosteronism produce systemic hypertension without arm-leg gradients. Takayasu arteritis can cause asymmetric limb pressures and absent pulses but typically affects young women, involves subclavian occlusion more than a discrete juxtaductal aortic narrowing, and does not classically cause rib notching.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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