Hypertension without renovascular stenosis: a rare case of abdominal aorta coarctation treated with percutaneous transluminal angioplasty

We describe a patient with a focal abdominal aortic stenosis without renovascular stenosis manifested as severe hypertension. Although hypertension and unilateral or bilateral renal artery stenosis are common in abdominal aortic stenosis, patients presenting with hypertension as the sole clinical feature without renal artery stenosis are rare. A 12-year-old boy was admitted to our department for severe hypertension (190/110 mmHg). The hypertension was found during a scheduled physical examination. His blood pressure control was poor despite taking 3 different antihypertensive agents (indapamide, amlodipine and telmisartan for over 2 months). He did not have any clinical manifestations other than hypertension and felt healthy with no constitutional symptoms such as fatigue, malaise, dizziness, myalgia, arthralgia, headache, claudication, weight loss or fever. There was no past history of a prolonged fever of unknown origin suggesting a diagnosis of Takayasu arteritis. The family history was negative for primary hypertension, cardiovascular, vasculitis or other familial diseases. The physical examination demonstrated that the patient was in good condition with a body weight and height in the normal range. Blood pressure in the right arm was 190/110 mmHg and in the left arm 185/90 mmHg. Bruit was audible on auscultation over the abdominal aorta. The bilateral femoral artery was non-palpable and blood pressure of both legs was undetectable. The patient’s erythrocyte sedimentation rate and C-reactive protein (CRP) were 2 mm/h (normal: 0-9 mm/h) and 0.8 mg/dl (normal: 0-0.36 mg/l). Serum Ig A, Ig E, Ig G, Ig M and complement C3 and C4 were normal. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative. The laboratory data revealed normal plasma renin activity (140 pg/ml), normal serum aldosterone levels and a normal glomerular filtration rate. Tests of infectious disease, such as hepatitis B, C, tuberculosis and HIV, were negative. An electrocardiogram (ECG) revealed a sinus rhythm, rate of 80 beats/min, and no ST changes. Echocardiography showed left ventricular hypertrophy with good systolic function. He received an abdominal angio-computed tomographic scan with volumetric reconstruction, which showed a focal stenosis at the suprarenal aorta with a minimum diameter of less than 2 mm and extensive collateral circulations (Figures 1 A-D). Echo-Doppler examination of the lower limbs demonstrated pulselessness of the bilateral femoral, popliteal and foot dorsal artery. Abdominal echo-Doppler revealed 60% obstruction of the aorCorresponding author: Wuxing Jiang MD, PhD Research Institute of General Surgery Jinling Hospital Nanjing University School of Medicine, Jian 210002 Nanjing, China Phone: 86-25-345123213 E-mail: dingwei_nju@ hotmail.com Letter to Editor