Question:
A 12 year old boy presented with weak pulses in upper limbs. His BP was 90/60mmHg. He also had retinal haemorrhages. Most likely diagnosis is
A 12 year old boy presented with weak pulses in upper limbs. His BP was 90/60mmHg. He also had retinal haemorrhages. Most likely diagnosis is
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Think about which large-vessel vasculitis causes absent pulses and is known as pulseless disease.
Updated On: Jun 23, 2026
- PAN (Polyarteritis Nodosa)
- Microscopic polyangiitis
- Takayasu arteritis
- HSP (Henoch-Schonlein Purpura)
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The Correct Option is C
Solution and Explanation
Step 1: Analyse the clinical presentation.
A 12-year-old boy with weak/absent pulses in upper limbs, low blood pressure (90/60 mmHg), and retinal haemorrhages. This combination points to large-vessel vasculitis affecting the aorta and its branches.
Step 2: Recall Takayasu arteritis.
Takayasu arteritis (pulseless disease / Martorell syndrome / occlusive thromboaortopathy) is a chronic granulomatous vasculitis predominantly affecting the aorta and its primary branches. It most commonly affects young females and adolescents. Features include: weak or absent pulses (especially upper limb), blood pressure discrepancy between limbs, bruits over subclavian/carotid arteries, claudication, vision problems (retinal haemorrhages, cotton-wool spots due to ocular ischaemia), and hypertension.
Step 3: Eliminate distractors.
PAN: affects medium-sized vessels, spares the lungs, causes renal and mesenteric involvement, not typically causing upper limb pulse loss.
Microscopic polyangiitis: small vessel ANCA-associated vasculitis causing glomerulonephritis and pulmonary haemorrhage.
HSP: IgA-mediated small vessel vasculitis causing palpable purpura on buttocks/legs, arthritis, abdominal pain, haematuria -- no pulse deficits.
Step 4: Confirm.
Absent upper limb pulses + low BP + retinal haemorrhages in a young patient = Takayasu arteritis.
A 12-year-old boy with weak/absent pulses in upper limbs, low blood pressure (90/60 mmHg), and retinal haemorrhages. This combination points to large-vessel vasculitis affecting the aorta and its branches.
Step 2: Recall Takayasu arteritis.
Takayasu arteritis (pulseless disease / Martorell syndrome / occlusive thromboaortopathy) is a chronic granulomatous vasculitis predominantly affecting the aorta and its primary branches. It most commonly affects young females and adolescents. Features include: weak or absent pulses (especially upper limb), blood pressure discrepancy between limbs, bruits over subclavian/carotid arteries, claudication, vision problems (retinal haemorrhages, cotton-wool spots due to ocular ischaemia), and hypertension.
Step 3: Eliminate distractors.
PAN: affects medium-sized vessels, spares the lungs, causes renal and mesenteric involvement, not typically causing upper limb pulse loss.
Microscopic polyangiitis: small vessel ANCA-associated vasculitis causing glomerulonephritis and pulmonary haemorrhage.
HSP: IgA-mediated small vessel vasculitis causing palpable purpura on buttocks/legs, arthritis, abdominal pain, haematuria -- no pulse deficits.
Step 4: Confirm.
Absent upper limb pulses + low BP + retinal haemorrhages in a young patient = Takayasu arteritis.
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