血管 CLASSIFICATION OF RIB NOTCHING

ARTERIAL

1. High aortic obstruction
a. Aortitis
b. Coarctation of aorta---most common
c. Coarctation of aorta involving left subclavianartery or anomalous right subclavian artery(unilateral)

2. Low aortic obstruction (eg, aortic thrombosis)

3. Subclavian artery obstruction
a. Blalock-Taussig operation (unilateral)
b. Pulseless disease (eg, Takayasu’s arteritis); ad-vanced arteriosclerosis

4. Pulmonary oligemia
a. Absent pulmonary artery (unilateral)
b. Ebstein’s anomaly
c. Emphysema
d. Pseudotruncus arteriosus
e. Pulmonary valvular stenosis or atresia
f. Tetralogy of Fallotg

VENOUS
1. Obstruction of superior vena cava, innominate orsubclavian vein

ARTERIOVENOUS
1. Arteriovenous fistula of chest wall (intercostal ar-tery—vein)
2. Pulmonary arteriovenous fistula

NEUROGENIC
1. Intercostal neurofibroma or neurilemmoma
2. Neurofibromatosis (type 1) ---Second common
3. Bulbar poliomyelitis; quadriplegia

OSSEOUS
1. Hyperparathyroidism
2. Osteodysplasty (Melnick-Needles syndrome)
3. Thalassemia

MISCELLANEOUS
1. Idiopathic; normal variant
2. Indwelling catheter

Coarctation of the aorta is the classic cause for this etiology but normally appears bilaterally and affects ribs 4-8 due to hypertrophy and tortuosity of the intercostal arteries. The first two ribs should be uninvolved because the first and second intercostal arteries are supplied by the superior intercostal branch of the costocervical trunk.

Nuerofibromatosis Type 1 is a second common etiology for rib notching with the development of intercostal neurofibromas causing the appearance. This is the number one non-vascular etiology.