Intercostal retractionsRetractions 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.
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.
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough airRead Article Now Book Mark Article
Intercostal retractions may be caused by:
- A severe, whole-body allergic reaction called anaphylaxis
Anaphylaxis is a life-threatening type of allergic reaction.Read Article Now Book Mark Article
Asthma is a chronic disease that causes the airways of the lungs to swell and narrow. It leads to breathing difficulty such as wheezing, shortness o...Read Article Now Book Mark Article
- Swelling and mucus buildup in the smallest air passages in the lungs (bronchiolitis)
Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles). It is usually due to a viral infection....Read Article Now Book Mark Article
- Problem breathing and a barking cough (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. ...Read Article Now Book Mark Article
- Inflammation of the tissue (epiglottis) that covers the windpipe
Epiglottitis is inflammation of the epiglottis. This is the tissue that covers the trachea (windpipe). Epiglottitis can be a life-threatening disea...Read Article Now Book Mark Article
- Foreign body in the windpipe
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...Read Article Now Book Mark Article
- 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)
Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It can be a life-threatening medical condition.Read Article Now Book Mark Article
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
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.Read Article Now Book Mark Article
- Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...Read Article Now Book Mark Article
- Pulse oximetry to measure blood oxygen level
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.
Review Date: 6/7/2022
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.