Coarctation of distal thoracic aorta--the middle aortic syndrome in an elderly female with severe coronary artery disease.

Coarctation of the distal aorta or middle aortic syndrome is a segmental stenosis of the middle portion of the aorta, between the arch and the terminal bifurcation. Middle aortic syndrome is a rare disease of infants and young adults presenting with hypertension, lower limb claudication and renal insufficiency and is diagnosed by aortography or magnetic resonance angiography. Our case is unique because this condition was an incidental finding diagnosed during cardiac catheterization in a 70-year-old patient with hypertension in the absence of lower-limb claudication. Recognition of this rare condition as a potential cause of secondary hypertension is important, especially given the wide age range of presentation.