Coarctation of the aorta is a congenital abnormality in which the aortic lumen is constricted just distal to the origin of the left subclavian artery. At this point, the aorta becomes significantly narrowed and the blood supply to the lower limbs and abdomen is diminished. Over time, collateral vessels develop around the chest wall and abdomen to supply the lower body. Dilated and tortuous intercostal vessels, which form a bypass to supply the descending thoracic aorta, may lead to erosions of the inferior margins of the ribs. This can be appreciated on chest radiographs as inferior rib notching and is usually seen in long standing cases. The coarctation also affects the heart, which has to pump the blood at higher pressure to maintain peripheral perfusion. This in turn may produce cardiac failure.