Roesler sign

Last revised by Daniel J Bell on 3 Mar 2021

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

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