Mnemonic

Chest Wall Layers

A memory aid for the layers crossed when passing a needle into the pleural cavity.

Expansion

Skin, fascia, muscle, three intercostal layers, endothoracic fascia, parietal pleura

Expansion

Passing from outside in:

  1. Skin
  2. Superficial fascia, with subcutaneous fat
  3. Deep fascia and the overlying muscle of the region (serratus anterior, latissimus dorsi or pectoralis major)
  4. External intercostal muscle
  5. Internal intercostal muscle
  6. Neurovascular bundle - vein, artery, nerve, in the costal groove
  7. Innermost intercostal muscle
  8. Endothoracic fascia
  9. Parietal pleura

Beyond that is the pleural cavity and then the visceral pleura on the lung. Knowing that the bundle lies between layers 5 and 7 is what makes the “above the rib” rule meaningful.