Chest examination
Prof . Magda Abdelsalam
Prof. Rehab El-Morsy
Professor of Chest Medicine
Mansoura University
Important land marks
Imaginary longitudinal lines
Imaginary chest areas
Surface anatomy of the lungs
Local chest examination
1 Inspection
2 palpation
3 percussion
4 auscultation
Chest inspection
• shape of the chest
• symmetry
• respiratory movement
• Pulsation
• dilated veins, pigmentation, sinuses,
fistula, nodules, scars of previous
operations, skin rashes
Inspection Shape of the chest
Normal chest has the following criteria:
•Elliptical in shape
•Both haves are symmetrical
•Anteroposterior diameter equals (5 ⁄ 7 ) of
the transverse diameter
•Ribs are oblique and no bulge or retraction
during inspiration
•Moves freely with respiration
•Subcostal angle 90 ±20
Shape of the chest
Abnormalities of the shape of the chest
• Barrel shaped chest
• Pigeon shaped chest
• Rachitic chest
• Funnel shaped chest
• Pectus excavatum
• Pectus carinatum
• kyphoscoliosis
Symmetry of the chest
• Normal chest is symmetrical
Abnormalities of the symmetry of the chest
• Bulge
• retraction
Respiratory rate
• It is measured by counting chest movement in one minute while
diverting the attention of the patient by pretending that you
measure the pulse rate to avoid voluntary changes in the rate.
• Normal rate: 12-20 breath per minute
Pulse- respiratory rate ratio
• Normal ratio: 4:1
Degree of chest expansion
• The patient is asked to breath in &out forcibly, then symmetrical areas
on both sides is compared while you are standing at bed foot and
looking tangentially.
Palpation of the chest
• superficial palpation
• Examination of trachea
• Confirmation of chest movement
• Tactile Vocal Fremitus (TVF)
• Palpable rhonchi or pleural rub
• Confirmation of the origin of pulsation
Superficial palpation
• By direct tapping by the tips of fingers over the clavicle and all regions
of the chest wall to detect crepitus over fractured rib or points of local
tenderness.
Confirmation of chest movement
Confirmation of chest movement
Tracheal examination
• Alternate palpation of trachea in
suprasternal notch by the tip of the index
finger.
• The tip of the index finger should be
placed in the fossa between the medial
aspect of the sternomastoid muscle and
the lateral aspect of the trachea .
• The patient is in a the sitting position,
leaning forward with the head straight and
supporting the head by the left hand.
Confirmation of the origin of pulsation
• Left second space: pulmonary artery dilatation
• Right second space : ascending aorta dilatation
Percussion of the chest
Sequence of percussion & auscultation
Types of percussion notes
Technique of chest percussion
Percussion of the anterior chest
•percussion of the clavicles by direct percussion, normally it is resonant.
•Percussion of the sternum is by direct percussion , normally the upper ⅔
sternum give cancellous resonance and the lower ⅓give impaired note.
•percussion of the upper border of the liver, normally dull is present in the
RT. 5th ICS midclavicular line and 7th ICS midaxillary line.
•parasternal lines: comparing each space on both sides.
•Midclavicular lines: normally resonant till 6th ICS( lower border of the lung)
•Midaxillary line: normally resonant till 8th ICS( lower border of the lung)
Technique of chest percussion
• Percussion of the posterior chest
• the scapula covers from 2nd to 7th rib with the arm at the sides.
• The inferior angle of the scapula is usually at 7 th intercostal space
serving as the usual landmark for counting the ribs in the back.
• Scapular line: normally resonant till 10 th ICS ( lower border of the
lungs)
• Paravertebral lines: normally resonant till 10 th ICS ( lower border of
the lungs)
Chest auscultation
• Intensity of breath sound
• Type of breath sound
• Vocal resonance
• Adventitious sounds
Chest auscultation
Sequence of percussion & auscultation
Adventitious sounds
Rhonchi ( wheezes)
Adventitious sounds
Crackles( crepitation)
