SHM Converge Scientific Abstract ePoster Gallery-Hypertensive Urgency in a 4-Year-Old Girl

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This case describes a 4-year-old girl who presented with severe hypertension (161/126) discovered at a routine clinic visit and was sent to the emergency department. Her only symptoms were polyuria, polydipsia, and weight loss, and her physical exam was initially unremarkable. Because pediatric hypertension is often secondary in origin, the differential diagnosis was broad and included renal, autoimmune, infectious, endocrine, and neurologic causes.<br /><br />She was admitted to the PICU and treated with oral antihypertensive medications, requiring several adjustments before her blood pressure improved. Initial laboratory tests were unrevealing. A first renal artery duplex was inconclusive, but on repeat exam a renal bruit was detected, and repeat duplex demonstrated 60% bilateral renal artery stenosis. Given concern for renovascular hypertension and possible middle aortic syndrome, CT angiography of the chest and abdomen was performed. This revealed a mediastinal mass, circumferential soft tissue around the abdominal aorta, and tissue encasing and narrowing both renal arteries.<br /><br />Biopsy of the lesions showed tuberculomas, establishing the diagnosis of extrapulmonary tuberculosis causing renal artery stenosis and hypertensive urgency. The patient was started on anti-tuberculosis therapy, and follow-up CT after six months showed decreased mass burden.<br /><br />The case highlights that while most pediatric hypertension is secondary and common causes of renal artery stenosis are congenital or related to fibromuscular dysplasia/atherosclerosis, rare infectious causes such as tuberculosis must also be considered. Tissue biopsy was essential to confirm the diagnosis and guide treatment.

Asset Subtitle

Jasmine Chau

Meta Tag

Author List Bianca Patel, Gina Kim, Jasmine Chau, Parastou Hosseini, Shea Nagle

Category Clinical Vignettes

Concept Pediatric Hypertension

Concept Secondary Hypertension

Concept Renovascular Disease

Concept Renal Artery Stenosis

Concept Hypertensive Urgency

Distinguished Finalist

Presenter Organization Los Angeles General Medical Center

Presenting Author Jasmine Chau

Track Pediatric

Keywords

pediatric hypertension

renal artery stenosis

extrapulmonary tuberculosis

hypertensive urgency

mediastinal mass

middle aortic syndrome

renal bruit

CT angiography

tuberculoma

anti-tuberculosis therapy

Pediatric Hypertension

Secondary Hypertension

Renovascular Disease

Renal Artery Stenosis

Hypertensive Urgency