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Intercostal retractions

Retractions of the chest muscles

 

Intercostal retractions occur when the muscles between the ribs pull inward. The movement is most often a sign that the person has a breathing problem.

Intercostal retractions are a medical emergency.

Considerations

 

The wall of your chest is flexible. This helps you breathe normally. Stiff tissue called cartilage attaches your ribs to the breast bone (sternum).

The intercostal muscles are the muscles between the ribs. During breathing, these muscles normally tighten and pull the rib cage up. Your chest expands and the lungs fill with air.

Intercostal retractions are due to reduced air pressure inside your chest. This can happen if the upper airway (trachea) or small airways of the lungs (bronchioles) become partially blocked. As a result, the intercostal muscles are sucked inward, between the ribs, when you breathe. This is a sign of airway obstruction. Any diseases or condition that causes a blockage in the airway will cause intercostal retractions.

 

Causes

 


  • Anaphylaxis
  • Asthma
  • Bronchiolitis
  • Croup
  • Epiglottitis
  • Foreign body in the windpipe (See: Foreign object aspiration or ingestion)
  • Pneumonia
  • Respiratory distress syndrome
  • Retropharyngeal abscess

 

When to Contact a Medical Professional

 

Seek medical attention right away if intercostal retractions occur. This can be a sign of airway blockage obstruction, which can quickly become life threatening.

Also seek medical care if the skin, lips, or nailbeds turn blue, or if the person becomes confused, drowsy, or is hard to wake up.

 

What to Expect at Your Office Visit

 

In emergency situations, the health care team will first take steps to help you breathe. You may receive oxygen, medicines to reduce swelling, and other treatments.

When you can breathe better, the doctor or nurse will examine you and ask questions about your medical history and symptoms, such as:

  • When did the problem start?
  • Is it getting better, worse, or staying the same?
  • Does it occur all the time?
  • Did you notice anything significant that might have caused an airway obstruction?
  • What other symptoms are there, such as blue skin color, wheezing, high-pitched sound when breathing, coughing or sore throat?
  • Has anything been breathed into the airway?

Tests that may be done include:

  • Arterial blood gases
  • Chest x-ray
  • Complete blood count (CBC)
  • Pulse oximetry to measure blood oxygen level

 

 

References

Watts KD, Goodman DM. Wheezing, bronchiolitis, and bronchitis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 383.

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        Review Date: 5/14/2014

        Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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