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

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.