This document discusses the anatomy of the anterior thoracic wall and intercostal spaces. It begins by outlining the learning objectives which are to describe the boundaries and contents of a typical intercostal space, including the muscles, nerves, blood vessels and lymphatics. It then provides detailed slides and explanations of the typical and atypical structures found in the intercostal spaces, including variations. Examples of clinical correlations and applied anatomy are also discussed, such as barrel chest deformities, congenital chest wall anomalies, and procedures involving the intercostal spaces.

1. Anterior thoracic wall
&
Intercostal Spaces
View slides @ www.slideshare.net
1
Maj Dr Rishi Pokhrel
NAIHS

2. 2

3. Learning objectives
• Typical intercostal space
– Boundaries and contents
– muscles
• Atypical intercostal space
3

4. 4

5. 5
Skin
Nerve supply
Blood supply
Lymphatic drainage

6. 6
Layers in thoracic wall

7. 7

8. 8
Thoracic skeleton post view

9. Typical rib
9

10. 10
Atypical ribs

11. Thoracic vertebrae
11

12. Sternum and Joints
12

13. Intercostal muscles
 External
 Internal
 Innermost
 Subcostalis
 Intercostalis intima
 Sternocostalis {transversus thoracis }
13

14. 14
Intercostal muscles

15. External and internal intercostal muscles
15

16. External and internal intercostal muscles
16

17. External and internal intercostal muscles
17

18. Subcostalis, Intercostalis intima & Sternocostalis
18

19. Intercostal arteries, nerves, and vein
19

20. Intercostal nerve
20

21. Intercostal nerve & its branches
21

22. 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.
22

23. • 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
23
TYPICAL INTERCOSTAL NERVE

24. Intercostal Arteries
24

25. Intercostal arteries
25

26. Anterior
intercostal
Arteries
Absent in 10th & 11th space
26

27. Posterior
intercostal
Arteries
27

28. Intercostal veins
anterior and posterior
30

29. Azygos system
31

30. Lymphatic drainage
32

31. Atypical intercostal space
• Typical space: typical nerve, rib and vertebra.
• Nerve: T3 - T6
• Ribs: 3 - 9
• Vertebrae: 2 - 8
33

32. Typical intercostal space
• 3rd - 6th space
34

33. Applied anatomy
35

34. Cervical Rib Syndrome
36

35. Gorilla rib
37

36. Shape
of
chest
38

37. 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
39

38. 40
Barrel chest

39. 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
41

40. 42
Pectus
excavatum

41. 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
43

42. Rachitic rosary
44

43. 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.
45

44. Pectus carinatum
46

45. Applied anatomy
• Thoracotomy – incisions
• Anterolateral
• Posterolateral
• Anterior
• Notching of ribs <– obstruction of aorta
47

46. Pleural tap / Paracentesis thoracis
48

47. 49