The causes of rib-notching are reviewed and classified. Although the sign is no longer pathognomonic of coarctation of the aorta, this condition is the most frequent underlying cause. A case of unilateral rib-notching, associated with a pulmonary arteriovenous fistula, is described. The rib-notching is attributed to dilated and tortuous intercostal arteries carrying a contributory systemic blood supply to the fistula. Three similar cases reported in the literature are mentioned.
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W A Wilson (1960) studied this question.
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