Asymmetric brachial blood pressure as an unusual presentation of pseudocoarctation of the aorta with giant aortic arch aneurysm

Coarctation of the aorta, a cause of secondary hypertension, usually presents with asymmetric blood pressure of the upper and lower extremities. However, pseudocoarctation of the aorta does not have pressure gradient cross the stenotic area, so blood pressure is the same over four extremities. We describe a case of pseudocoarctation of the aorta, which presented unusually as a giant aortic arch aneurysm with asymmetric brachial blood pressure in a 52-year-old male. He was hypertensive and had a history of relatively lower blood pressure in his left arm. A diagnosis of pseudocoarctation of the aorta with giant aortic arch aneurysm was made according to the results of chest X-rays, computed tomography, cardiac echocardiography and catheterization. Under cardiopulmonary bypass, the giant aortic arch aneurysm were resected and replaced with an 18-mm woven graft. Based on a MEDLINE search up to 2007, we believe that this is the first reported case of pseudocoarctation of the aorta presenting with asymmetric brachial blood pressure. Physicians should keep in mind that measurement of blood pressure in the four extremities is necessary in all cases of suspected aortic arch disease with hypertension.