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In reference to the muscles of the thoracic wall, the intercostal nerves and vessels run posterior to the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal pleura, except when they are covered by the innermost intercostal muscles, innermost intercostal membrane, subcostal muscles or the transversus thoracis muscle.
[2]: 321 Counting ribs is essential attempting to make a thoracic incision; an incision at the first or second rib interspace can result in damage to large, important blood vessels and the brachial plexus. Identification of the second rib and thus the second intercostal space inferiorly is useful when auscultating heart sounds.
The accessory hemiazygos vein varies inversely in size with the left superior intercostal vein.. It usually receives the posterior intercostal veins from the 4th, 5th, 6th, 7th, and 8th intercostal spaces between the left superior intercostal vein and highest tributary of the hemiazygos vein; [3] the left bronchial vein sometimes opens into it.
The endothoracic fascia is deep to the intercostal space. The endothoracic fascia is the layer of loose connective tissue deep to the intercostal spaces and ribs, separating these structures from the underlying pleura. This fascial layer is the outermost membrane of the thoracic cavity. The endothoracic fascia contains variable amounts of fat.
They are marked by sublamellar, slightly retractive axial ribs, of which 14 occur upon the first and second and 18 upon the penultimate turn. The intercostal spaces are smooth and three times as wide as the ribs. The periphery is deeply and broadly sulcate, bordered on each side by a low spiral cord, crossed by the continuations of the axial ribs.
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[2] It's when the zone of apposition ( the portion of the diaphragm in contact with the parietal pleura during expiration in the base of the pleural cavity') is reduced by the flattening of the diaphragm during inspiration and the pressure in the last intercostal spaces changes from intra-abdominal to intra-thoracic pressure.