Inferior rib notching – refers to a remodeling deformity of the lower aspect of the ribs, usually induced by dilated intercostal vessels. Arterial dilatation most commonly occurs when there is obstruction of the aorta such as in coarctation, while venous dilatation may occur in the setting of SVC obstruction. In both settings the intercostal vessels act as collaterals to bypass the primary vascular obstruction with the rib notching being a secondary effect. Nerve sheath tumours are the major non-vascular cause of inferior rib notching.
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