Question:medium
A chest radiograph obtained in a male with hypertension. What will be the diagnosis?
A chest radiograph obtained in a male with hypertension. What will be the diagnosis?
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Young hypertensive male: look at the rib undersurfaces and the aortic knuckle for a number 3.
Updated On: Jun 23, 2026
- Tetralogy of Fallot
- Ebstein's anomaly
- TAPVC
- Coarctation of aorta
Show Solution
The Correct Option is D
Solution and Explanation
Clinical link first: A hypertensive young man with a chest film showing rib notching means coarctation of the aorta until proven otherwise.
In coarctation the aorta is narrowed, so blood detours through the intercostal arteries to reach the lower body. These overworked, dilated vessels press on the rib undersurfaces and scallop them, producing inferior rib notching. At the narrowing itself the aortic shadow kinks into a 3-shape, the pre-stenotic dilatation forming the top curve and the post-stenotic dilatation the lower curve, the classic figure-3 sign. The heart is usually normal in size in older children.
Eliminate the rest: A boot-shaped heart with dark lungs is TOF, a wall-to-wall box heart is Ebstein's, and a snowman silhouette is supracardiac TAPVC. Only coarctation pairs systemic hypertension with rib notching and the figure-3 sign.
Ref: Bailey and Love, 27th edition.
In coarctation the aorta is narrowed, so blood detours through the intercostal arteries to reach the lower body. These overworked, dilated vessels press on the rib undersurfaces and scallop them, producing inferior rib notching. At the narrowing itself the aortic shadow kinks into a 3-shape, the pre-stenotic dilatation forming the top curve and the post-stenotic dilatation the lower curve, the classic figure-3 sign. The heart is usually normal in size in older children.
Eliminate the rest: A boot-shaped heart with dark lungs is TOF, a wall-to-wall box heart is Ebstein's, and a snowman silhouette is supracardiac TAPVC. Only coarctation pairs systemic hypertension with rib notching and the figure-3 sign.
Ref: Bailey and Love, 27th edition.
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