A 9-year-old boy being evaluated for headache and upper limb hypertension has a chest X-ray showing notching of the inferior surfaces of ribs 3 to 8 bilaterally and a 'figure 3' deformity of the descending aortic contour. Which lesion best explains these radiographic findings?

• A Coarctation of the aorta ✓
• B Tetralogy of Fallot
• C Patent ductus arteriosus with pulmonary hypertension
• D Supravalvular aortic stenosis

Explanation

Rib notching on the inferior rib surfaces results from erosion by dilated, tortuous posterior intercostal arteries acting as collaterals around a juxtaductal coarctation. Collaterals do not develop until mid-childhood, so the sign appears after several years and explains why coarctation can present with arm hypertension in an older child. The figure 3 contour reflects prestenotic and poststenotic dilation of the aorta at the coarctation site.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.