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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 a blocked airway . Any health problem that causes a blockage in the airway will cause intercostal retractions.
Blocked airway
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
Causes
Intercostal retractions may be caused by:
-
A severe, whole-body allergic reaction called
anaphylaxis
Anaphylaxis
Anaphylaxis is a life-threatening type of allergic reaction.
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Asthma
Asthma
Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughi...
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Swelling and mucus buildup in the smallest air passages in the lungs (
bronchiolitis
)
Bronchiolitis
Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles). It is usually due to a viral infection....
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Problem breathing and a barking cough (
croup
)
Croup
Croup is breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children....
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Inflammation of the tissue (
epiglottis
) that covers the windpipe
Epiglottis
Epiglottitis is inflammation of the epiglottis. This is the tissue that covers the trachea (windpipe). Epiglottitis is a life-threatening disease....
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-
Pneumonia
Pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
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A lung problem in newborns called
respiratory distress syndrome
Respiratory distress syndrome
Neonatal respiratory distress syndrome (RDS) is a problem often seen in premature babies. The condition makes it hard for the baby to breathe....
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Collection of pus in the tissues in the back of the throat (
retropharyngeal abscess
)
Retropharyngeal abscess
Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It can be a life-threatening medical condition.
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When to Contact a Medical Professional
Seek medical help right away if intercostal retractions occur. This can be a sign of a blocked airway, 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.
Confused
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Drowsy
Drowsiness refers to feeling abnormally sleepy during the day. People who are drowsy may fall asleep in inappropriate situations or at inappropriate...
What to Expect at Your Office Visit
In an emergency, 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 health care provider will examine you and ask 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
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
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Complete blood count
(CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
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References
Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 385.
Sarnaik AP, Clark JA, Sarnaik AA. Respiratory distress and failure. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 71.
Review Date: 5/18/2016
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.
