Severe Hypertension in a 4-Year-Old Child

The diagnosis and management of acute pediatric hypertension in the ED aim to minimize end-organ dysfunction. Severe hypertension is often due to a secondary cause for which a systems-based approach can guide the development of a pertinent differential diagnosis. Traditionally, history, physical examination, and laboratory data guide the initial narrowing of the differential. When a vascular cause is suspected, echocardiography and/or CT imaging will often lead to a diagnosis. This case demonstrates that ED ultrasound is both effective and rapid in facilitating the ability to make this diagnosis. It may also assist in quickly ruling out other diagnoses before any other imaging studies are performed or laboratory values seen. The learning curve for emergency ultrasound is relatively low, and its use can lead to improved outcomes with relatively little risk to the patient. Finally, for treatment of a hypertensive emergency or urgency, a handful of medications that decrease peripheral vascular resistance can provide immediate blood pressure control. However, some agents may be more effective for certain causes, furthering the need to establish a timely diagnosis. © 2007.