An uncommon cause of hypertensive urgency in young adolescent: Case report

Abstract

Mid Aortic Syndrome is an uncommon aetiology of hypertensive urgency in children with poor outcome if left untreated, so there is a need for prompt diagnosis of hypertensive urgency followed by timely referral to a tertiary care centre which would reduce its complications and mortality Not Applicable as Case Report Case report: A 12-year-old boy presented with fever, puffiness of face and breathing difficulty. On clinical examination, he had hypertension so initially we considered renal aetiology as a cause of his hypertension, hence he was managed conservatively with intravenous antihypertensive drugs followed by oral antihypertensive drugs. As his hypertension was uncontrollable medically, he was investigated for underlying causes with USG abdomen with renal Doppler and 2D Echo which were normal. In view of differential blood pressures in upper limbs and lower limbs we suspected obstructive component in aorta, so a paediatric cardiologist was specifically asked to look at distal Aorta on 2D Echo. Later CT angiography was done which showed significant abdominal aortic constriction without involvement of renal/mesenteric vessels. Percutaneous balloon dilatation of aorta was done considering growing age of the child and normal renal, mesenteric vessels. Post operatively we could wean anti-hypertensive drugs to keep his blood pressures below 50th centile for his age, height and sex.