Anatomy
Thorax
A 21 year old patient presents to ED with a primary spontaneous pneumothorax. You are asked by your consultant to perform a pleural aspiration. When inserting the needle, it should be placed:
Answer:
The needle should be inserted just superior to the upper border of a rib to avoid damaging the neurovascular bundle which runs in the costal groove along the inferior margin of the rib.Intercostal Space
Anatomy / Thorax / Thoracic Wall
Last Updated: 11th April 2019
The intercostal space lies between adjacent ribs and mostly contains intercostal muscles. Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.
Intercostal nerves and major associated arteries and veins lie in the costal groove along the inferior margin of the rib, lying in a plane between the internal and innermost intercostal muscles.
Costal Groove of Central Rib on Left Side (Inferior View). (Original image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Clinical Significance
In each space, the vein is the most superior structure and is therefore highest in the costal groove. The artery is inferior to the vein and the nerve inferior to the artery and often not protected by the groove. Therefore the nerve is the most vulnerable structure in a penetrating injury to the upper aspect of the intercostal space. Small collateral branches of the major intercostal nerves and vessels are often present superior to the inferior rib below.
Any needle or tube (e.g. in needle thoracocentesis, pleural aspiration or chest drain insertion) being inserted in the intercostal space should be placed immediately above the superior margin of a rib to avoid injury to the intercostal neurovascular bundle.
Report A Problem
Is there something wrong with this question? Let us know and we’ll fix it as soon as possible.
Loading Form...
- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
