A child presents with asymptomatic hypertension and weak femoral pulses. What is the likely diagnosis?

The presentation of asymptomatic hypertension along with weak femoral pulses is highly indicative of coarctation of the aorta. This condition involves a narrowing of the aorta, typically just distal to the left subclavian artery. As a result of this narrowing, blood flow to the lower body is reduced, which leads to weak or absent pulses in the lower extremities, such as the femoral pulses.

In coarctation of the aorta, blood pressure can be elevated in the upper body due to the increased workload of the heart pumping against the narrowed segment of the aorta, while the lower body experiences decreased blood flow and pressure. Therefore, the presence of hypertension in the arms (or head) alongside weakness in the femoral pulses presents a classic clinical picture of this condition.

Recognizing these signs is crucial, as coarctation can lead to significant complications if not diagnosed early, including hypertensive emergencies and end-organ damage.