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.
The differentials differ according to whether it is the superior or inferior surface that is notched.
Superior rib notching
- abnormal osteoblastic activity
- abnormal osteoclastic activity
Inferior rib notching (Roesler sign)
- enlarged collateral vessels
- coarctation of the aorta
- interrupted aortic arch
- subclavian artery obstruction
- arteriovenous malformation (AVM) of the chest wall
- superior vena cava obstruction with enlarged venous collaterals
- pulmonary AVM
- tetralogy of Fallot
- neurogenic tumors