Physical findings associated with selected conditions in pediatric hypertensive emergencies and urgencies

Organ	Conditions	Findings*
Brain	Hypertensive encephalopathy	Severe elevation of BP Lethargy Coma Seizures
	Severe head trauma with intracranial injury	Signs of head trauma Headache Vomiting Altered mental status Seizures Cushing triad (hypertension, bradycardia, and abnormal respirations) Focal neurological deficits Bulging fontanelle
	Child abuse	As above and Retinal hemorrhage Suspicious fractures^¶ Suspicious bruising^¶
	Mass lesion (CNS tumor or abscess)	As for head trauma and Ataxia Neck pain Diplopia Papilledema Visual field defects
Eye	Hypertensive retinopathy	Papilledema Exudates Retinal hemorrhage in the absence of signs of abuse
Heart	Heart failure	Dyspnea on exertion Orthopnea Edema Diaphoresis with exercise or feeding (infant) Cyanosis Chest pain Tachycardia Gallop rhythm Apical heave Bibasilar rales Hepatomegaly
Heart	Coarctation of the aorta	Upper extremity pulse and/or BP greater than lower extremity pulse and signs of heart failure Murmur
Adrenal gland	Pheochromocytoma	Headache Diaphoresis Paroxysmal flushing Pallor Tachycardia
Adrenal gland	Cushing syndrome	Truncal obesity Weight gain Acne Striae Moon facies Upper back adiposity ("buffalo hump") Hirsutism
Thyroid gland	Hyperthyroidism	Weight loss Anxiety Depression Heat intolerance Exophthalmos Thyromegaly Tachycardia Hyperglycemia
Kidney	Renal parenchymal disease	Hematuria or "tea-colored" urine Oliguria/anuria Edema Growth retardation
	Post-infectious glomerulonephritis	As above and recent Group A streptococcal infection/exposure, pharyngitis, or impetigo
	Hemolytic uremic syndrome	Pallor Bloody diarrhea Hematuria
	Renovascular disease	Abdominal or flank bruit
	Polycystic kidney disease Congenital renal anomalies Wilms tumor Neuroblastoma	Abdominal mass
Skin	Neurofibromatosis	Café au lait spots Axillary freckling Cutaneous neurofibromas
	Tuberous sclerosis	Ash leaf patches
	Vasculitis Systemic lupus erythematosus	Rash

BP: blood pressure; CNS: central nervous system.

* These lists represent common features associated with the given condition. An individual patient with a specific condition may not display all of these findings. Other conditions may exist in patients with these clinical findings.

¶ For bruising and fracture patterns that are suspicious for physical child abuse, refer to UpToDate content on recognition of physical child abuse.

Graphic 79975 Version 6.0

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Physical findings associated with selected conditions in pediatric hypertensive emergencies and urgencies