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Rib notching

Last revised by Calum Worsley on 15 Apr 2022

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Worsley C, kurian N, et al. Rib notching. Reference article, Radiopaedia.org (Accessed on 12 Oct 2024) https://doi.org/10.53347/rID-5229

DOI:

https://doi.org/10.53347/rID-5229

Permalink:

https://radiopaedia.org/articles/5229

rID:

5229

Article created:

20 Dec 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

15 Apr 2022, Calum Worsley ◉

Disclosures:

At the time the article was last revised Calum Worsley had no financial relationships to ineligible companies to disclose.

View Calum Worsley's current disclosures

Revisions:

28 times, by 19 contributors - see full revision history and disclosures

Systems:

Chest, Musculoskeletal

Sections:

Gamuts

Tags:

refs

Synonyms:

Causes of rib notching
Notching of the ribs
Notching of the rib
Superior rib notching
Inferior rib notching

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

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 tumors
- 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.

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