Intercostal retractions

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Intercostal retractions are the inward movement of the muscles between the ribs as a result of reduced pressure in the chest cavity. The movements are usually a sign of difficulty with breathing.

Retractions of the chest muscles

The chest wall is flexible, which allows for normal breathing. Cartilage that attaches the ribs to the sternum (breast bone) allows free movement of bony structures so that the rib cage can expand and contract. During breathing, the muscles between the ribs (intercostal muscles) contract and pull the rib cage upward while the diaphragm moves downward, thus increasing the volume of the chest cavity and causing air to be drawn into the lungs.

When the trachea (upper airway) or the smaller bronchioles (small airways of the lungs) become partially blocked so that air flow is restricted, the normal increase in chest cavity size reduces the pressure within the chest and the intercostal muscles are drawn inward, between the ribs. This sucking in of the chest muscles is a sign of airway obstruction. Diseases or conditions that cause restriction of the airway will cause intercostal retraction.

• Croup
• Pneumonia
• Bronchiolitis
• Foreign body in the trachea (see foreign object aspiration or ingestion)
• Epiglottitis
• Asthma
• Anaphylaxis
• Retropharyngeal abscess
• Respiratory distress syndrome

Review Date: 05/10/2006
Reviewed By: Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.