Differential Diagnosis for Discrepancy in Arm and Leg Blood Pressure Readings
Single Most Likely Diagnosis
- Aortic Coarctation: This condition, characterized by narrowing of the aortic isthmus, typically presents with significantly higher blood pressure readings in the arms compared to the legs. The provided readings (95/60 in the arm and 190/100 in the leg) are suggestive of a reversed pattern, but considering the significant discrepancy, it prompts consideration of aortic coarctation or a similar obstructive process affecting blood flow, albeit the typical pattern is the opposite.
Other Likely Diagnoses
- Peripheral Arterial Disease (PAD): While PAD typically causes higher blood pressure readings in the arms compared to the legs due to arterial narrowing, the significant discrepancy in the provided readings could be indicative of severe PAD affecting the lower limbs, although the pattern is unusual.
- Aorto-iliac Occlusive Disease: This condition involves narrowing or blockage of the aorto-iliac arteries, which could lead to decreased blood pressure in the legs compared to the arms. However, the provided readings show higher pressure in the legs, suggesting an atypical presentation or another underlying issue.
Do Not Miss Diagnoses
- Aortic Dissection: Although the blood pressure pattern is not typical, aortic dissection is a life-threatening condition that can cause discrepancies in blood pressure readings between limbs due to the disruption of normal aortic flow. It's crucial to consider this diagnosis due to its high mortality rate if missed.
- Hypertensive Emergency: The significantly elevated blood pressure in the legs (190/100) could indicate a hypertensive emergency, especially if there are signs of end-organ damage. Prompt recognition and treatment are essential to prevent serious complications.
Rare Diagnoses
- Takayasu Arteritis: A large vessel vasculitis that can cause stenosis or occlusion of major arteries, including those supplying the arms and legs, potentially leading to discrepancies in blood pressure readings. It's a rare condition but should be considered in the differential diagnosis, especially in younger patients.
- Middle Aortic Syndrome: A rare condition characterized by narrowing of the abdominal aorta, which could potentially cause discrepancies in blood pressure readings between the arms and legs, although it's more commonly associated with renovascular hypertension.