rib notching
Notching of
the ribs An case image from radiopaedia, showing inferior rib notching from coarctation of the aorta
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
- 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
- tetralogy of Fallot
- neurogenic tumors
- schwannoma (usually single)
- neurofibromatosis type 1 (rarely can be superior if neurofibroma is very large)
Superior and inferior rib notching
