Intercostal space

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Intercostal space
Intercostal spaces, viewed from the left.
Sternocostal and interchondral articulations. Anterior view.
Latin	spatium intercostale
Gray's	subject #28 123
Dorlands/Elsevier	s_16/12746516

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The intercostal space is the space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces.

Importance of intercostal space

Because the chest is protected by the rib cage, the intercostal spaces are important access points in medicine, for example:

• access for surgical procedures, e.g. resection of (part of) the lung (pneumonectomy), or insertion of a chest tube, performance of pericardiocentesis
• penetrating trauma of the thorax
• for percussion and auscultation of underlying structures, e.g. sites for heart auscultation, percussion in Traube's space, etc.

Structures in intercostal space

• several kinds of intercostal muscle
• intercostal arteries and associated veins
• lymphatics
• nerves

Order of components

Comprehensive insight in the anatomy of the intercostal spaces is mandatory for everyone who practices medicine. One particular concept is that the neurovascular bundle has a strict order: V-A-N, or vein-artery-nerve, from top to bottom (as illustrated). This neurovascular bundle runs high in the intercostal space: therefore, the intercostal space should be penetrated as low as possible by invasive procedures.

In reference to the muscles of the thoracic wall, the intercostal nerves and vessels run just behind the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal pleura, except when they are covered by the innermost intercostal muscles, subcostal muscles or the transversus thoracis muscle.

External links

• Anatomy at MUN thorax/space
• Intercostal+space at eMedicine Dictionary
• SUNY Figs 18:04-00 - "Structural organization within an intercostal space."
• SUNY Labs 18:01-0108 - "Thoracic Wall: The Anterior Thoracic Wall"

v • d • e General anatomy of torso
Thorax/ Thoracic cavity	Mediastinum (Superior, Anterior, Middle, Posterior) • Superior thoracic aperture • Inferior thoracic aperture • Triangle of auscultation • Intercostal space • Thoracic plane • Thoracic wall/Thoracic cage - fascia (Pectoral fascia, Clavipectoral fascia, Thoracolumbar fascia) • Chest • Midsternal line
Thoracic diaphragm	openings (Caval opening, Esophageal hiatus, Aortic hiatus, Foramina of Morgagni) • Central tendon • Crus of diaphragm • arcuate ligaments (Lateral, Medial, Median)
Abdomen/ Abdominal cavity	Retroperitoneum • Paracolic gutters • Hepatobiliary triangle anterior abdominal wall (Arcuate line, Linea alba, Tendinous intersection, Linea semilunaris, McBurney's point, Traube's space, Inguinal triangle) • Inguinal canal (Deep inguinal ring, Superficial inguinal ring, Intercrural fibers, Crura of superficial inguinal ring) • Lumbar triangle • regions (Epigastrium, Hypochondrium, Umbilical region, Latus, Hypogastrium, Inguinal region) • planes (Transpyloric plane, Intertubercular plane, Midclavicular line) fascia (Fascia of Camper, Fascia of Scarpa, Transversalis fascia, Renal fascia, Rectus sheath)
Pelvis/ Pelvic cavity	Pelvic floor • Retropubic space fascia (Pelvic fascia, Superior fascia of diaphragm of pelvis, Inferior fascia of diaphragm of pelvis, Fascia of the Obturator internus, Tendinous arch, Iliac fascia, Iliopectineal fascia)
Perineum	Anal triangle (Ischioanal fossa, Pudendal canal, Anococcygeal raphe) Urogenital triangle (Superficial perineal pouch, Deep perineal pouch) Perineal body fascia (Dartos/fascia of perineum/superficial perineal fascia/Fascia of Colles, Perineal membrane/"Inferior fascia of UGD", "Superior fascia of UGD")