Figure of 3 Sign - Coarctation of the Aorta on Chest X-Ray

The figure of 3 sign refers to the appearance of the aorta. There’s a focal indentation of the distal aortic arch caused by the coarcted segment of the aorta.

In this case, Roesler sign is absent. Roesler sign refers specifically to inferior rib notching. The rib notching is caused by dilated intercostal collateral vessels which try to bypass the coarctation and supply the descending aorta.

This sign is not seen in infancy and rare in children under 5 years as the intercostals take time to develop and erode the inferior surface of the ribs. Commonly seen in long-standing cases usually involving the 4th to 8th ribs and sparing the 1st and 2nd rib.

Dr. Devpriyo Pal @drdevrad

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