A 5-day-old term male infant presents with poor feeding and pallor. Femoral pulses are feeble while brachial pulses are easily palpable. Blood pressure is 95/60 mmHg in the right arm and 70/45 mmHg in the legs. Echocardiography shows a juxtaductal narrowing with a patent ductus arteriosus. Which is the most likely diagnosis?

• A Coarctation of the aorta ✓
• B Total anomalous pulmonary venous connection
• C Tricuspid atresia
• D Ebstein anomaly

Explanation

An arm-to-leg systolic blood pressure gradient with weak or absent femoral pulses in a sick neonate is the hallmark of coarctation of the aorta. It is commoner in males and strongly associated with bicuspid aortic valve and Turner syndrome. In total anomalous pulmonary venous connection all pulses are typically preserved with pulmonary venous congestion dominating, and tricuspid atresia and Ebstein anomaly produce right-sided findings rather than a differential upper-lower limb pulse pattern.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.