A 9-year-old boy is found hypertensive on routine screening, with BP 150/95 mmHg in both arms and 100/60 mmHg in the legs. A soft continuous murmur is heard over the interscapular area. Which finding on chest X-ray would BEST support the diagnosis?

• A Boot-shaped heart
• B Snowman appearance
• C Egg-on-side silhouette
• D Rib notching of the inferior surfaces of posterior ribs ✓

Explanation

Upper limb hypertension with radiofemoral delay indicates postductal coarctation of the aorta. Collateral flow through dilated intercostal arteries erodes the inferior surface of posterior ribs (usually ribs 3 to 8), producing the classic '3' sign and rib notching on chest X-ray. The boot shape belongs to tetralogy of Fallot and egg-on-side to transposition, neither of which produces differential arm-leg blood pressures.

Reference: Park's Pediatric Cardiology for Practitioners, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.