The left lateral chest radiograph FIGURE 2 displayed narrowing of the trachea at the 3 rd ribs laterally reflecting dilatation of the brachiocephalic trunk and left common carotid artery; thin subcutaneous tissues, and left ventricular enlargement.
An inverted image FIGURE 3 of Figure 1 provided a different perspective of the proximal and distal dilated coarctation of the aorta and rib notching of the posterior 6 th right rib, heads of the asymmetric clavicles over the posterior asymmetric 3 rd ribs. An aortogram, FIGURE 4 , requested by the thoracic surgeon was prior to the surgical correction of the post ductal coarctation, displayed narrowing at the insertion of the ductus arteriosus of aorta and dilatation of the ascending aorta; dilation of the brachiocephalic trunk, internal carotid arteries and subclavian arteries, dilated right thyrocervical trunk, and dilated left intercostal arteries.
A diagram of the diagnostic dilatation in neurofibromatosis compared with those in hyperparathyroidism FIGURE 5 displayed rib notching caused by abnormal dilated vessels accompanying such entities as coarctation of the aorta from Isadore Meschan, Synopsis of Analysis of Roentgen Signs in General Radiology, ; p Coarctation of the aorta is a constriction of the aortic arch, either in its ascending or descending portion.
Coarctations can bevategorized into two groups based on the position of the constriction with respect to the ductus arteriosus:. Pre ductal — Usually found in infants and most commonly accompanied by other cardiac defects such as ventricular septal defects, bicuspid aortic valve and patent ductus arteriosus.
The clinical presentation of aortic coarctation results from the differential blood flow to various portions of the aorta. Descending on the location of the stricture, there may be, for example, reduced cerebral blood flow as well as poor perfusion of one arm or of both legs. If problems do not arise in early infancy, symptoms usually do not become obvious until early adolescence. Commonly, systemic hypertension or an abnormal chest radiograph may be the first manifestations of the disorder.
On physical examination, diminished pulses in the lower extremities is seen as well as hypertension in the arms and hypotension in the legs. Complications arising from this anomaly include congestive heart failure as well as either a rupture or dissection of the aorta. Other possible complications include stroke resulting from a ruptured aneurysm of the circle of Willis and endocarditis usually associated with a bicuspid aortic valve.
The radiographic presentation in the adult, post-ductal type, as seen in this case, usually involves findings on routine PA and lateral chest radiographs. The actual coarctation may be displayed. One may also observe the pre-stenotic dilatation of the aortic arch and left subclavian artery and post-stenotic dilatation of the aorta.
Other findings result from increased collateral flow. This includes dilatation of the internal thoracic artery, brachiocephalic and thyrocervical trunk arteries. Rib notching, observed in this case, is a common finding in this condition.
It results from the pressure of dilated intercostal arteries on the inferior margins of the ribs. This is more obvious in the AP view and usually involves the fourth to eighth ribs. The notching is usually symmetric. If it is isolated to the right side, the stenosis may be proximal to the origin of the left subclavian artery. Therefore collateral flow must develop from the adequately supplied right subclavian artery through the right rib collaterals to the descending aorta.
If notching is isolated to the left side there must be higher pressures in the left subclavian artery than the right, to have increased flow from the left through left rib collaterals to the descending aorta.
This could occur if there is an aberrant left subclavian artery proximal to the right with the coarctation proximal to the right subclavian artery, and distal to the left subclavian artery. Uniform rib notching can occur in other disorders, which produce increased flow to the descending aorta over the subclavian arteries or increased flow through the rib collateral secondary to lung disease. These disorders include:. Become a Gold Supporter and see no ads.
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Gaillard, F. Rib notching. Reference article, Radiopaedia. Chest , Musculoskeletal. Superior rib notching Inferior rib notching Notching of the rib Notching of the ribs Causes of rib notching. URL of Article. Differential diagnosis The differentials differ according to whether it is the superior or inferior surface that is notched. Quiz questions. Primer of Diagnostic Imaging. Read it at Google Books - Find it at Amazon 2. Bone and Joint Disorders.
Read it at Google Books - Find it at Amazon 3. Pulmonary function in progressive systemic sclerosis. Pubmed 4. Sim MM. Unilateral rib notching in a tetralogy of Fallot. Accessory roentgen signs of coarctation of the aorta. Untersuchungen an zwei Fallen von Isthmusstenose der Aorta. Quoted from Gladnikoff. The legacy of Johann Friedrich Meckel the Elder : a 4-generation dynasty of anatomists.
A6 - Pubmed 8. Disesa VJ.
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