Rib notching

Changed by Matt Skalski, 2 May 2016

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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

abnormal osteoblastic activity
- osteogenesis imperfecta
- connective tissue diseases
- local pressure
abnormal osteoclastic activity
- hyperparathyroidism
~~abnormal muscle pull~~miscellaneous
- neurofibromatosis type 1
- restrictive lung disease
- poliomyelitis
- progeria
- abnormal muscle pull

Inferior rib notching (Roesler sign)

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
neurogenic tumours
- schwannoma (usually single)
- neurofibromatosis type 1 (rarely can be superior if neurofibroma is very large)

Superior and inferior rib notching

~~-<li>abnormal muscle pull<ul>~~
+<li>miscellaneous<ul>
+<li>abnormal muscle pull</li>

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