A 30-year-old man is admitted to the emergency department because of significant nose bleeding and a headache that has worsened over several days. He also complains of fatigue. Upon examination it is noted that brachial artery pressure is markedly increased, femoral pressure is decreased, and the femoral pulses are delayed. The patient shows no external signs of inflammation. Which of the following is the most likely diagnosis?

Increased arterial pressure in the upper limbs (as demonstrated in the brachial artery) and decreased pressure in the lower limbs (as demonstrated in the femoral artery) are common symptoms of coarctation of the aorta. Other symptoms include tortuous and enlarged blood vessels above the coarctation and an increased risk of cerebral hemorrhage. This condition of coarctation occurs when the aorta is abnormally constricted during development. The patient does not complain of respiratory distress, so cor pulmonale would not likely be the underlying condition. Dissection of the right common iliac artery would not result in nosebleed or headache. Obstruction of the superior vena cava would not account for decreased femoral pulse. A pulmonary embolism will not present with these findings.