Routine Fundoscopy: Unravelling Undiagnosed Significant Coarctation of the Aorta

A 10-year-old boy was brought to the outpatient department with complaints of diminished vision for two years. On examination, the best-corrected visual acuity (BCVA) in oculus dexter (OD) was 20/40 and in oculus sinister (OS) was 20/80. The patient was dilated for routine fundoscopy, which revealed grade IV hypertensive retinopathy changes in both eyes, with a macular fan in the left eye. The patient's blood pressure was promptly checked and, as suspected, was high. An emergency pediatric medicine consultation was done where it was noted that the patient's peripheral pulses were feeble, and he had cold extremities. The blood pressure was 200/140 mmHg in the upper limb and 90/60 mmHg in the lower limb. An echocardiogram revealed significant coarctation of the aorta (CoA), further confirmed by a CT angiogram. This case report highlights the importance of comprehensive fundoscopic examination for detecting potentially fatal cardiac conditions.