Aortic coarctation chest x-ray


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S.[mailto:psingh@perfuse.org], ; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S.[mailto:kfeeney@perfuse.org]

Overview
Aortic coarctation on chest Xray presents with irregular notching of the inferior margins of the posterior ribs resulting from collateral flow through dilated and pulsatile intercostal arteries. An inverted "3" sign of the barium-filled esophagus or a "3" sign on a highly penetrated chest radiograph may be visualized. Signs of congestive heart failure - Cardiomegaly, pulmonary edema, prominent pulmonary vasculature

Chest x-ray

 * Irregularities or notching of the inferior margins of the posterior ribs results from collateral flow through dilated and pulsatile intercostal arteries. These collateral appear after 6 years of age if the coarctation is significant.
 * An inverted "3" sign of the barium-filled esophagus or a "3" sign on a highly penetrated chest radiograph may be visualized. Post-stenotic dilation of the aorta results in a classic 'reverse 3 sign' on x-ray. The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the aortic wall at the site of cervical rib obstruction, with consequent post-stenotic dilation. This physiology results in the reversed '3' image for which the sign is named.
 * Signs of congestive heart failure - Cardiomegaly, pulmonary edema, prominent pulmonary vasculature

Chest X-ray below showing 3 sign and arrows pointing to notching of ribs.