Rib notching in coarctation of the aorta

This is a penetrated view of the posterior ribs on the right side of chest. The notching is on the lower edges due to dilatation of the intercostal arteries. It affects ribs 4, 5, and 6 where it is maximal. This comes from a 30 year old male with coarctation of the aorta and was present bilaterally.

Unilateral rib notching at this site can occur following thoracotomy and failed shunt in cyanotic heart disase.

In this patient, the coarctation is at classic site at T4. When it is lower, rib notching will affect lower ribs. It will not be present in abdominal coarctation.