A 19-year-old man presents with refractory hypertension despite lisinopril monotherapy. Vital signs reveal BP 165/98 mmHg bilaterally, HR 88/min, RR 16/min. Physical examination demonstrates weak femoral pulses and delayed lower extremity capillary refill. Chest radiograph shows notching of the inferior rib borders and a narrowed aortic knob. Serum creatinine is 1.2 mg/dL. Femoral-brachial pulse delay is present. Which of the following best explains these radiographic findings?
- A)Chronic osteomyelitis of the ribs from bacteremia
- B)Calcification of costal cartilage due to chronic hypercalcemia
- C)Dilation of pulmonary arteries causing extrinsic rib compression
- D)Compression fractures due to osteoporosis
- E)Erosion by enlarged intercostal arteries acting as collateral vesselsGABARITO
Explicação
Postductal coarctation leads to development of collateral circulation through intercostal arteries to bypass the narrowed aortic segment. Enlarged pulsatile intercostal arteries erode the undersurface of ribs, producing rib notching on imaging. The weak femora... Ver explicação completa e trilha adaptativa →