SummaryThis case report concerns a 44 year old man presenting with a systolic murmur on the back of the thorax, an elevated systolic blood pressure in the upper extremities, differential blood pressure between upper and lower extremities and decreased pulses in the lower extremities. Computed tomography of the thorax, after contrast injection, revealed extensive calcification with narrowing at the descending thoracic aorta. Aorta catheterization detected a pressure gradient of 20 mm Hg over this atherosclerotic narrowing, localized at the descending aorta. Aortic angiography revealed an irregular narrowing of the descending aorta and also a se cond irregular narrowing, immediately under the origin of the cranial mesenteric artery extending over two vertebras.A review of the literature concerning coarctation and pseudocoarctation of the aorta allows us to conclude that the presented case is a variant form of aortic coarctation (not described until now). This variant form is due neither to a congenital anomaly nor to kinking of the aorta but to atherosclerosis.