Intercostal retractions
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.
Causes
Intercostal retractions may be caused by:
- A severe, whole-body allergic reaction called anaphylaxis
- Asthma
- 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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Croup
Croup is an infection of the upper airways that causes breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. ...
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- Foreign body in the windpipe
- Pneumonia
- 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....
Read Article Now Book Mark Article - Collection of pus in the tissues in the back of the throat (retropharyngeal abscess)
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.
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
- Complete blood count (CBC)
- Pulse oximetry to measure blood oxygen level
Reviewed By
Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Brown CA, Walls RM. Airway. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 1.
Rodrigues KK, Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 412.
Stephany A. Respiratory distress. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 4.