Bilateral blood pressure measurement using ultrasound angioscanning and flow spectrogram assessment in the abdominal aorta in an adolescent with secondary arterial hypertension due to previously undiagnosed aortic coarctation

Aortic coarctation is one of the etiological factors of secondary arterial hypertension. Owing to prenatal diagnostics and modern neonatal screening protocols, in most cases aortic coarctation is identified during the neonatal period. However, according to the literature, in older children and adults aortic coarctation is missed in approximately 85% of cases, even in the presence of such clinical manifestations as heart murmur or arterial hypertension. The article presents a clinical case of an adolescent with newly diagnosed type III aortic coarctation (complete form), complicated by secondary arterial hypertension. Analysis of the literature data and diagnostic errors observed in the patient’s work-up allowed to highlight the following diagnostic approaches that significantly facilitate timely and accurate diagnosis.
1.    Bilateral blood pressure measurement at the initial examination of adolescents and adult patients with arterial hypertension, particularly in cases of refractory hypertension and the presence of a cardiac murmur.
2.    In situations of technical difficulties in blood pressure measurement by conventional methods (auscultatory, oscillometric, etc.) in the lower extremity arteries, it is recommended to assess systolic pressure by Doppler ultrasound following the method of ankle–brachial index measuring. A simplified approach can be applied by preliminarily assessing the shape of the flow spectrogram.
3.    Mandatory screening ultrasound evaluation of the abdominal aorta should be included in the basic protocol of transthoracic echocardiography.

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