Author: Salem Almerri / Editor: Stephen Sheridan / Codes: CC7, CC9, SLO1, SLO2, SLO9 / Published: 05/12/2025
A 32-year-old man presents to emergency department (ED) after being found to have elevated blood pressure during a military fitness assessment. He doesn’t complain of any headaches, dizziness, chest pain, palpitations, or any other unusual symptoms. He has no significant past medical or surgical history, takes no medications, and does not smoke or drink alcohol. He is physically active as part of his military duties.
On examination, his BP is 174/98 mmHg in both arms and 132/80 mmHg in both legs. The patient has palpable bilateral radial pulses but comparably weaker and delayed femoral pulses. On Pericordial examination, a continuous systolic-diastolic murmur between scapula, and harsh systolic ejection murmur in aortic area. Cardiovascular and respiratory examinations are otherwise unremarkable.
Chest X-ray reveals figure 3 sign and rib notching [Image 1]. ECG demonstrates evidence of left ventricular hypertrophy.
This is a classical chest radiography that shows the 3 sign (dotted line) and rib notching (arrows).1
8 responses
Nicely described thanks.
Wow! Thank you for this. Interesting!
Interesting case, thank you.
Excellent recall
After final year , Xray seen today only ,thank you
good case
good case thank you