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A 20 year old girl had uncontrolled hypertension and absent lower limb pulses. Transoesophageal echocardiography was done. Cross section of the descending aorta at T8 and T9 vertebral level showed an irregular shaped lumen (below left, panel A, arrows; AO, aorta). There was intimal thickening. Long axis imaging showed long segment tight stenosis with the typical rat tail deformity (panel B, arrows) of the lumen. The narrowest diameter was 2 mm while the normal segment above was 11 mm. Non-specific aortoarteritis was diagnosed. Descending aortic injection confirmed the above findings (below right). There was irregular luminal narrowing with rat tail deformity.