Unilateral Rib Notching

Rib notching can be caused by collateral flow through intercostal vessels from the following conditions:

• Coarctation of the aorta proximal to the left subclavian artery: Right-sided
• Coarctation of the aorta with an aberrant right subclavian artery: Left-sided. Occurs when the aberrant right subclavian artery arises after the coarctation.
• Subclavian artery stenosis: Ipsilateral to the side of stenosis
• Blalock-Thomas-Taussig shunt: Ipsilateral to the side of shunt. Due to division of all the branches of the first part of the subclavian artery performed during shunt creation.
• Neurofibromatosis of the intercostal nerves:
• Vascular malformations of the thoracic wall: Enlarged intercostal veins cause the rib notching.
• Superior vena cava obstruction: Due to development of collateral channels to the inferior vena cava via the intercostal veins
• Taboparesis:

References

• Shapiro S, Schrire V. Unilateral notching of the ribs in cyanotic heart disease. Br Heart J. 1964 Sep; 26:620-4.