Rib notching

Last revised by Dr Calum Worsley on 15 Apr 2022

Rib notching refers to deformation of the superior or inferior surface of the rib. It can affect a single rib (from trauma or solitary masses e.g. schwannoma) or can affect multiple ribs.

Differential diagnosis

The differentials differ according to whether it is the superior or inferior surface that is notched.

Superior rib notching
Inferior rib notching
Superior and inferior rib notching

History and etymology

Hugo Roesler (1899-1961) 8, an Austrian-American radiologist, was the first to describe the characteristic inferior rib notching of coarctation of the aorta, in 1928, hence Roesler sign 5,6. Just over a century earlier, the German anatomist Johann Friedrich Meckel (the younger), (1781-1833) 7 recorded the presence of rib notching in coarctation on cadaveric studies in 1827 5.

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Cases and figures

  • Case 1: coarctation
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  • Case 1: intercostal collaterals
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  • Case 2: coarctation of the aorta
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  • Case 3: coarctation of aorta
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  • Case 4: coarctation of the aorta
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  • Case 5: coarctation of the aorta
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  • Case 6: coarctation of the aorta
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  • Case 7: coarctation of the aorta
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  • Case 8: aortic coarctation - ductal
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  • Case 9: superior and inferior
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  • Case 10: aortic coarctation
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