Epistaxis, persistent hea...

A 13-year-old girl presented epistaxis, persistent headache and uncontrolled hypertension to the clinic. She had no H/O dizziness, syncope or contact with the TB patient. Upon clinical examination, there was a BP discrepancy of 50/40 mm of Hg between the two arms. There were bruits over numerous areas, including the abdominal aorta. The aortogram reports are shown in the figure. The Arch aortogram showed a hugely dilated (70mm) arch of the aorta, which became abruptly normal (35mm) just after the origin of the left subclavian artery. 

A right bracheo-cephalic artery had ostio-proximal stenosis with marked post stenotic dilatation (figure A). There was also ostio-proximal stenosis of the left common carotid and left subclavian artery with post stenotic dilatation. (Figure B). The abdominal aortogram revealed critical stenosis of the abdominal aorta above the origin of renal arteries with an 80/11 mm Hg pressure gradient (figure C).