Roesler sign is the name given to the inferior rib notching seen in coarctation of the aorta. Although by no means pathognomonic, the sign is fairly specific. Although many other causes of inferior rib notching have been recorded most of them are very rare 1.
Strictly-speaking it is only called Roesler sign when the etiology of the inferior rib notching is coarctation.
History and etymology
Hugo Roesler (1899-1961) 3, a radiologist working in Vienna, who later emigrated to the USA, was the first to describe the characteristic inferior rib notching of coarctation of the aorta, in 1928 1,2. Just over a century earlier, the German anatomist Johann Friedrich Meckel (the younger), (1781-1833) 4 recorded the presence of rib notching in coarctation of the aorta in cadavers in 1827 1.
Interestingly, Roesler sign was thought to be pathognomonic for coarctation of the aorta until a paper published in 1948. This demonstrated unequivocally that inferior rib notching could also be seen in neurofibromatosis type 1 5.
Differential diagnosis
Other causes of inferior rib notching
- enlarged collateral vessels
- coarctation of the aorta
- interrupted aortic arch
- subclavian artery obstruction
- Takayasu disease
- Blalock-Taussig shunt: involves only upper two rib spaces
- arteriovenous malformation (AVM) of the chest wall
- superior vena cava obstruction with enlarged venous collaterals
- pulmonary AVM
- tetralogy of Fallot
- neurogenic tumors
- schwannoma (usually single)
- neurofibromatosis type 1 (rarely can also be superior notching if a neurofibroma is very large)
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