A Rare Cause of Unilateral Rib Notching
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IMAGES IN CARDIOLOGY A Rare Cause of Unilateral Rib Notching Ravindran Rajendran, MD, Anand P. Subramanian, MD, DM, Jayranganath Mahimarangaiah, MD, DM, Manjunath C. Nanjappa, MD, DM Bangalore, India From the Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India. Manuscript received September 27, 2012; accepted October 2, 2012. A 19-year-old male with cyanosis and clubbing was diagnosed with tetralogy of Fallot (TOF). Chest x-ray (A) showed prominent rib notching involving the left hemithorax (arrow). Major aortopulmonary collaterals (arrows) suggested by the rib notching were confirmed by a computerized tomogram (B, C, Online Video 1). Post-operatively he had pulmonary edema, secondary to these collaterals. Aortic angiogram (H, Online Video 2) showed tortuous posterior intercostal arteries eroding the lower margins of the corresponding ribs. Indirect collaterals arising from these vessels were supplying the left lung that were suc- cessfully coil embolized (I, Online Video 3). The TOF anatomy is demonstrated from D to G. Rib notching secondary to Major aorto- pulmonary collaterals is rare, as they do not run in the intercostal grooves (1), but when they arise from the inter costal arteries, notching of ribs could be expected as in this case. @ in- fundibular pulmonary stenosis; IVS interventricular septum; LA left atrium; LPA left pulmonary artery; LV left ventricle; PA pulmonary artery; RPA right pulmonary artery; RV right ventricle; VSD ventricular septal defect. REFERENCE 1. Wong HO, Ang AH. Unilateral rib notching in Fallot’s tetrology due to systemic pulmonary collateral vessels. Br Heart J 1973;35:226 – 8. Journal of the American College of Cardiology Vol. 61, No. 19, 2013 © 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.10.062
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Transcript of A Rare Cause of Unilateral Rib Notching
Journal of the American College of Cardiology Vol. 61, No. 19, 2013© 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00
IMAGES IN CARDIOLOGY
A Rare Cause of Unilateral Rib NotchingRavindran Rajendran, MD, Anand P. Subramanian, MD, DM,Jayranganath Mahimarangaiah, MD, DM, Manjunath C. Nanjappa, MD, DMBangalore, India
From the Department ofCardiology, Sri JayadevaInstitute of CardiovascularSciences & Research,Bangalore, India.Manuscript receivedSeptember 27, 2012;accepted October 2, 2012.
A19-year-old male with cyanosis and clubbing was diagnosed with tetralogy of Fallot(TOF). Chest x-ray (A) showed prominent rib notching involving the left hemithorax(arrow). Major aortopulmonary collaterals (arrows) suggested by the rib notching
were confirmed by a computerized tomogram (B, C, Online Video 1). Post-operatively he hadpulmonary edema, secondary to these collaterals. Aortic angiogram (H, Online Video 2)showed tortuous posterior intercostal arteries eroding the lower margins of the correspondingribs. Indirect collaterals arising from these vessels were supplying the left lung that were suc-cessfully coil embolized (I, Online Video 3).
The TOF anatomy is demonstrated from D to G. Rib notching secondary to Major aorto-pulmonary collaterals is rare, as they do not run in the intercostal grooves (1), but when theyarise from the inter costal arteries, notching of ribs could be expected as in this case. @ � in-fundibular pulmonary stenosis; IVS � interventricular septum; LA � left atrium; LPA � leftpulmonary artery; LV � left ventricle; PA � pulmonary artery; RPA � right pulmonary artery;RV � right ventricle; VSD � ventricular septal defect.
Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.10.062
REFERENCE
1. Wong HO, Ang AH. Unilateral rib notching in Fallot’s
tetrology due to systemic pulmonary collateral vessels. BrHeart J 1973;35:226–8.
