Hitting the Target in Abdominal Aortic Coarctation

BACKGROUND: Abdominal aortic coarctation (AAC) is a rare cause of severe hypertension in adolescents and is often associated with Takayasu arteritis. CASE SUMMARY: We present a case of a 15-year-old boy with a 4-month history of progressive dyspnea and easy fatiguability. He was found to have severe systemic hypertension, radiofemoral delay, and a significantly higher upper limb blood pressure (BP) compared with lower limb BP. Computed tomography aortography demonstrated severe AAC. He underwent successful endovascular intervention with stenting of the abdominal aorta. Hypertension and symptoms resolved immediately postintervention. DISCUSSION: AAC may occur as a congenital anomaly or secondary to inflammatory conditions such as Takayasu arteritis, particularly in young individuals with severe hypertension. This case underscores the value of physical examination and imaging in the evaluation of a young patient with hypertension. TAKE-HOME MESSAGE: Severe hypertension with radiofemoral delay and an upper-to-lower limb BP gradient >20 mm Hg prompted evaluation for AAC.