Anterior thoracic wall

&

Intercostal Spaces

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View slides @ www.slideshare.net

Maj Dr Rishi Pokhrel

NAIHS

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Learning objectives

• Typical intercostal space– Boundaries and contents– muscles

• Atypical intercostal space

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SkinNerve supplyBlood supplyLymphatic drainage

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Layers in thoracic wall

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Thoracic skeleton post view

Typical rib

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Atypical ribs

Thoracic vertebrae

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Sternum and Joints

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Intercostal muscles

External

Internal

Innermost

Subcostalis

Intercostalis intima

Sternocostalis {transversus thoracis }13

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Intercostal muscles

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External and internal intercostal muscles

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External and internal intercostal muscles

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External and internal intercostal muscles

Subcostalis, Intercostalis intima & Sternocostalis

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Intercostal arteries, nerves, and vein

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Intercostal nerve

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Intercostal nerve & its branches

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TYPICAL INTERCOSTAL NERVE

1. Lateral cutaneous with anterior and posterior branches.

2. Anterior cutaneous nerve with medial and lateral cutaneous branch.

3. Lie within the intercostal space.4. Supply structure within its space.

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• T1 and T2 give branch to brachial plexus• T1 has no lat or ant cutaneous branch• T2 has lateral cutaneous (intercostobrachial)

nerve but no branches• T7 to T11 cross their corresponding spaces to

supply the anterior abdominal wall.• Typical : T3 to T6

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TYPICAL INTERCOSTAL NERVE

Intercostal Arteries

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Intercostal arteries

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Anterior intercostal ArteriesAbsent in 10th & 11th space

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Posterior intercostal Arteries

Intercostal veinsanterior and posterior

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Azygos system

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Lymphatic drainage

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Atypical intercostal space

• Typical space: typical nerve, rib and vertebra. • Nerve: T3 - T6• Ribs: 3 - 9• Vertebrae: 2 - 8

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Typical intercostal space

• 3rd - 6th space

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Applied anatomy

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Cervical Rib Syndrome

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Gorilla rib

Shape of

chest

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Barrel chest

• Large ribcage, round torso• Increase in the A-P diameter of the chest wall • Causes– Normal– Acromegaly– Emphysema– Osteoarthritis of joints of thorax

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Barrel chest

Pectus excavatum

• Commonest congenital deformity of anterior chest wall

• Several ribs and the sternum grow abnormally.• Caved-in or sunken appearance of the chest• Aka cobbler's chest, sunken chest, or funnel

chest• Asymptomatic to severe cardiac / pulmonary

symptoms

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Pectus excavatum

Rachitic rosary

• Aka beading of the ribs• Prominent knobs of bone at the costochondral

joints • Knobs - beads under the skin of the rib cage, • Beads of a rosary• Cause - Rickets

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Rachitic rosary

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Pectus carinatum• Opposite of pectus excavatum protrusion of the

sternum and ribs• Aka pigeon chest• Overgrowth of cartilage causing the sternum to

protrude forward• Causes• During pubertal growth in males• Congenital ? hereditary• Post- surgical i.e. median sternal thoracotomy• Turner syndrome, Marfan syndrome, Ehlers Danlos Syndrome, Morquio syndrome, Noonan syndrome, Trisomy 18, Trisomy 21,

homocystinuria, osteogenesis imperfecta, multiple lentigines syndrome, Sly syndrome and Scoliosis.

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Pectus carinatum

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Applied anatomy

• Thoracotomy – incisions

• Anterolateral

• Posterolateral

• Anterior

• Notching of ribs <– obstruction of aorta

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Pleural tap / Paracentesis thoracis

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