]> 2026-07-31T09:40:09+00:00 WBR0043 0 en Kerley B lines Rib notching The patient's radiologic signs, heart murmur, and symptoms are consistent with post-ductal coarctation of the aorta. Due to increased resistance proximal to the coarctation, collateral arterial circulation often develops. The collateral circulation often manifests as dilated intercostal vessels, which impinge on the inferior surface of ribs. These vessels appear as "rib notching" on X-ray. Cardiomegaly Pleural effusion Patchy alveolar infiltrates Pathology Gonzalo Romero (Reviewed by Will Gibson and Yazan Daaboul) A 6-year-old boy is brought to his pediatrician's office for severe headache and nosebleeds over the past six months. The patient complains that his feet become very cold at night for which he has been wearing two pairs of thick socks. At school, he gets occasional cramps in his legs and is easily winded when running in gym class. His blood pressure is 170/95mmHg in the both upper extremities and 100/70 mmHg in both lower extremities, heart rate is 80/min, respiratory rate is 15/min, and temperature is 37 °C (98.6 °F). On physical examination, he has clear breath sounds bilaterally, but a continuous murmur is heard over the inter-scapular area. A chest x-ray demonstrates prominence of the descending aorta compared to the spine. Which of the following findings on chest x-ray is most specific for this patient's condition? B Cardiology 2020-10-27T23:08:49Z 2459150.464456 WBR0043