The transversus thoracis (triangularis sterni) arises by a tendinous origin from the posterior surface of the lower sternum and xiphoid, with slips inserting into the inner surfaces of the 2nd-6th costal cartilages. Its tendinous origin is the most consistent component and is encountered during median sternotomy.
The transversus thoracis tendinous origin is transected during median sternotomy and must be reapproximated during sternal closure. The internal thoracic artery and veins lie immediately posterior to the muscle, making haemostasis critical. Calcification of the transversus thoracis is a recognised radiographic variant visible on lateral chest X-ray as a curved opacity behind the sternum.
Sternal avulsion of the transversus thoracis origin during forceful expiratory effort or chest trauma, presenting as anterior chest pain reproduced by deep inspiration.
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