ON THE COVER A 51-year-old female was admitted for the treatment of congestive heart failure. She was initially diagnosed with aortic stenosis at 34 years old and has been treated with enalapril. Physical examination revealed a discrepancy of blood pressure between the arms and legs. The right brachial blood pressure was 140/75 mm Hg and the ankle blood pressure was 87/58 mm Hg. The chest roentgenogram showed rib notching/erosion bilaterally and a "figure three" sign in the left upper mediastinum. Electrocardiographic-gated 64-slice computed tomography (A) demonstrated a luminal narrowing and a post-stenotic dilatation of the descending aorta. The three-dimensional (3D) volume-rendering image depicted enlarged internal thoracic arteries and thoracoacromial arteries that indicate the development of collateral circulation (B). In the 3D images of the right ribs, the dilated and tortuous intercostal arteries are clearly visualized in accordance with rib notching of the 4th to 7th ribs (C and D). She was diagnosed with aortic coarctation and underwent prosthetic graft implantation to bypass the stenotic region. Images provided by Hayato Otani, MD, Hiroshi Satoh, MD, Keiichi Odagiri, MD, Masashi Machii, MD, Tsuyoshi Urushida, MD, Hideki Katoh, MD, Hideharu Hayashi, MD, from the Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan