A 12-year-old with leg pain on activity, an ejection click, weak and delayed femoral pulses, elevated BP in both arms, and rib notching is most likely diagnosed with which condition?

• A. Abdominal aortic aneurysm.
• B. Pheochromocytoma.
• C. Coarctation of the aorta.
• D. Thoracic outlet syndrome.

Answer: (C)

Coarctation of the aorta. This congenital narrowing, typically just beyond the left subclavian artery, raises pressure in the upper body while reducing flow to the lower body. That explains the elevated blood pressure in the arms and the weak, delayed femoral pulses, as well as leg pain with activity from claudication due to diminished distal perfusion. Rib notching results from enlarged intercostal arteries developing as collaterals to bypass the narrowed segment. An associated bicuspid aortic valve can produce an ejection click. The overall pattern fits coarctation in a child or adolescent far better than an abdominal aneurysm, pheochromocytoma, or thoracic outlet syndrome.