Intercostal Antidote to Hubris

Next time you get ready to Own the Chest Tube, think about these 2 angiography images of the course of the intercostal arteries.

No Ethel, the intercostals aren’t stuck firmly to the inferior margin of the rib.They wander all over creation. Perhaps, they intentionally wiggle and try to impale themselves on the tip of your needle. I believe that one vessel in the second image crosses the equator into northern Queensland.

intercostal artery 1 intercostal artery 2

Yoneyama H, Arahata M, Temaru R, Ishizaka S, Minami S. Evaluation of the risk of intercostal artery laceration during thoracentesis in elderly patients by using 3D-CT angiography. Intern Med. 2010;49(4):289-92. Epub 2010 Feb 15. PMID: 20154433.

Here’s the free fulltext link for you:

Thanks to Erik Adler, MD  for finding this truly obscure but thoroughly frightening little article.

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    • Rick Abbott says

      Which brings up 2 points: chest tube is likely safer because of the blunt insertion -- as compared with thoracentesis with a nice pointy needle. And, for technical or traditional reasons, thoracentesis is often done posteriorly where tortuosity and inferior positioning of the artery within the intercostal space is maximal. While chest tube insertion is often more lateral where the tortuosity is less and the artery more closely approximates the inferior border of the rib. See the details in this article, as well as the article by Choi et al in J Medical Imaging and Radiation Oncology which has further details on location (local girl from NSW).

      Choi S, Trieu J, Ridley L. Radiological review of intercostal artery: Anatomical considerations when performing procedures via intercostal space. J Med Imaging Radiat Oncol. 2010 Aug;54(4):302-6. PubMed PMID: 20718909.