PROF.DR.K.H.NOORUL AMEEN’S UNIT M6

DR.M.ARIVUMANI

IMAGE OF THE WEEK

45 Year old male patient Known hypertensive admitted with complaints of chest pain, epistaxis for 2 days duration

o/e patient concious oriented BP 180/110mmhg CVS S1,S2 heard,no murmur RS NVBS,no added sounds P/A soft CNS NFND

Chest x ray taken

Chest x ray PA view Inspiratory film Normal penetration No rotation Soft tissues normal Lung fields normal Rib notching seen in inferior borders of posterior

ribs prominently seen in 3rd to 8th ribs.

X Ray changes in coarctatation of aorta

Chest X ray Notching of inferior border 3rd to 9th posterior ribs

due to erosion by dilated collaterals(beween braches of subclavian and posterior intercostal arteries).

‘3’ sign-indentation of aorta at the site of coarctation , dilatation of left subclavian artery and poststenotic dilatation of aorta along paramediastinal border.

Cardiomegaly Rib erosion seen in lower ribs in case of abdominal

coarctation. E sign in barium filled oesophagus

Causes of rib notching

Superior border rib notching Normal finding in elderly Rheumatoid arthritis SLE Hyperparathyroidism Marfan syndrome Neurofibromatosis Poliomyelitis

Inferior rib notching Unilateral BT shunt Subclavian artery ooclusion Coarctation involving anamalous right subclavian artery

Inferior rib notching Bilateral Coarctatation of aorta takayasu arteritis Subclavian atheroma TOF,PS,Truncus arteriosus type 4 SVC/IVC obstruction Intercostopulmonary fistula/AV fistula Hyperparathyroidism Neurogenic Idiopathic

THANK YOU