RIB NOTCHING

B i.e. Waterston Cooley’s shunt

A, B, C, i.e. Hyperparathyroidism, Poliomyelitis, Marfan syndome

A i.e. Neurofibromatosis; C i.e. Aortic aneurysm

A i.e. Coarctation of aorta 

Inferior rib notching in coarctation of aorta is d/t pressure erosion of intercostal arteriesQ It usually takes several years to develop, so is unusual before 10 years of age.

Answer is D (Neurofibromatosis)

Neurofibromatosis is associated with superior rib notching

Inferior rib notching is characteristically seen in coarctation of Aorta and may also be seen in Superior vena cava obstruction and a Blalock-Taussig shunt operation

Rib-Signs in Coarctation of aorta:

• Inferior rib notching is characteristic, and is believed to be due to pressure erosion by intercostal arteries.
• Inferior rib notching takes several years to develop and is rarely seen before the age of 8 years.e
• ‘3’ sign^emay be seen due to enlargement of left subclavian artery above the coarctation
• Usually spares fist two ribs^e where intercostal arteries arise from costocervical trunk which is proximal to the usual site of CA. Mostly commonly affected ribs are the 4^th to 8^th ribs.
• Usually bilateral but asymmetrical.

Ans. C: Coarctaation of Aorta

Radiological sign of coarctation of aorta:

Rib Notching

• Single best sign
• Older the person, more likely to have rib notching
• Majority have it over 20 years of age
• Rib notching occurs in the high pressure circuit
• Most often involves 4th-8th rib
• Sometimes may involve 3rd and 9th
• Does not involve 1st and 2nd ribs
• Intercostals come off costocervical trunk and do not supply collateral flow to descending aorta
• 4th-8th do anastomose with internal mammary to form collaterals for descending aorta
• Rib Notching-Unilateral

Ans. All of the above

Ans. None