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

## TL;DR

A child with high blood pressure was later found to have a rare heart condition missed during initial tests, emphasizing the need for thorough exams and repeat testing.

## Contribution

Highlights diagnostic challenges in CoA and advocates for comprehensive evaluation of pediatric hypertension.

## Key findings

- Delayed diagnosis of CoA occurred due to omitted lower extremity blood pressure and pulse assessment.
- Successful treatment followed detection of diminished femoral pulses and repeat echocardiography.
- Emphasizes the importance of guideline-based evaluations to avoid diagnostic delays in pediatric hypertension.

## Abstract

Coarctation of the aorta (CoA) remains a frequently underrecognized cause of secondary hypertension in children. We report a case of a preadolescent with persistent, treatment-resistant hypertension initially evaluated with normal echocardiograms and extensive workups, including renal, endocrine, and genetic testing. Importantly, lower extremity blood pressure and femoral pulse assessment were omitted during initial evaluations. After referral to pediatric cardiology, diminished femoral pulses were detected and a third echocardiogram revealed severe CoA, later confirmed by CT angiography. The patient underwent successful stent placement, resulting in blood pressure normalization and discontinuation of all antihypertensive medications. This case highlights the diagnostic pitfalls associated with incomplete physical examination and reliance on a single imaging modality. It reinforces the importance of guideline-based evaluation for pediatric hypertension, including routine assessment of femoral pulses and four-limb blood pressure measurements. In cases of persistent hypertension with high clinical suspicion despite inconclusive initial imaging, repeat echocardiography or advanced imaging should be considered to prevent diagnostic delays and optimize outcomes.