Bilateral rib notching is seen in -: (A) Coarctation of aoa, (B) PDA, (C) TAPVC, (D) All of the above
Answer is A. The differentials differ according to whether it is the superior or inferior surface that is notched. Superior rib notching * abnormal osteoblastic activity o osteogenesis imperfecta o connective tissue diseases SS rheumatoid ahritis SS systemic lupus erythematosus (SLE) SS Marfan syndrome SS Sjogren's syndrome SS scleroderma o local pressure * abnormal osteoclastic activity o hyperparathyroidism * miscellaneous o neurofibromatosis type 1 o restrictive lung disease o poliomyelitis o progeria o abnormal muscle pull Inferior rib notching (Roesler sign) * enlarged collateral vessels o coarctation of the aoa o interrupted aoic arch o subclan aery obstruction SS Takayasu disease SS Blalock-Taussig shunt: involves only upper two rib spaces o aeriovenous malformation (AVM) of the chest wall o superior vena cava obstruction with enlarged venous collaterals o pulmonary AVM o tetralogy of Fallot * neurogenic tumors o schwannoma (usually single) o neurofibromatosis type 1 (rarely can be superior if neurofibroma is very large) Superior and inferior rib notching * hyperparathyroidism * neurofibromatosis type 1