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Reminder of important clinical lesson
Incidental detection of late presenting co-arctation of the aorta on chest x-ray: the importance of rib notching
  1. Richard Roger Warne1,
  2. Jeremy Sze Luong Ong2,
  3. Conor P Murray1
  1. 1Department of Interventional and Diagnostic Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Richard Roger Warne, Richard.Warne{at}


A 31-year-old obese male presented to the emergency department with symptoms and signs suggestive of a viral upper respiratory tract illness with a background of low exercise tolerance. Rib notching was identified on plain film chest radiography and subsequent CT of the thorax identified a moderately tight 2-mm juxta-ductal co-arctation of the aorta with multiple enlarged chest wall collaterals. The patient underwent a two-stage percutaneous procedure involving stent insertion and angioplasty up to 16 mm with significant improvement in exercise capacity and a modest reduction in blood pressure.

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  • Competing interests None.

  • Patient consent Obtained.

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