Rib notching

Changed by Daniel J Bell, 3 Mar 2021

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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
miscellaneous
- neurofibromatosis type 1
- restrictive lung disease
- poliomyelitis
- progeria
- abnormal muscle pull

Inferior rib notching (Roesler sign)

enlarged collateral vessels
- coarctation of the aorta (Roesler sign)
- 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 ⁴
neurogenic tumours
- schwannoma (usually single)
- neurofibromatosis type 1 (rarely can be superior if neurofibroma is very large)

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.

~~-</ul><h5>Inferior rib notching (Roesler sign)</h5><ul>~~
+</ul><h5>Inferior rib notching</h5><ul>
~~-<li><a href="/articles/coarctation-of-the-aorta">coarctation of the aorta</a></li>~~
+<li>
+<a href="/articles/coarctation-of-the-aorta">coarctation of the aorta</a> (<a href="/articles/roesler-sign">Roesler sign</a>)</li>

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Inferior rib notching

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