A site for medical students - Practical,Theory,Osce Notes

Normal shape of Chest

  • Normal chest is bilaterally symmetrical without undue elevation or depression,
  • Truncated cone-shaped  with transverse diameter > anteroposterior diameter and vertical is the highest ,elliptical in cross section.
  • The normal anteroposterior to transverse diameter ratio is 5 : 7. 
  • The normal subcostal angle is 90°. 
  • It is more acute in males than in females.
  • Both the sides of the chest move simultaneously and symmetrically
Look for the following in inspection of chest:
Crowding of ribs
Patient should be in sitting or standing posture
Crowding of ribs should be made out from the back
Standing behind the patient by sliding the fingers along the lower intercostal spaces on either sides and comparing them
Supraclavicular and Infraclavicular fossa
Supraclavicular and Infraclavicular fossa hollowing is seen following 
  • Fibrosis 
  • Collapse of the lung, 
  • Malnutrition
Flattening of chest
Unilateral flattening of the chest
It is seen in 
  • Fibrosis 
  • Collapse of lung
The skin over the chest wall is examined for the following:
  • Engorged veins and subcutaneous nodules seen in sarcoid and malignancy
  • Intercostal scar  are drained pleural effusion, empyema or pneumothorax
  • Discharging sinuses is seen in Tuberculosis
  • Empyema necessitans in which there is an intercostal swelling close to the sternum.
  • Features of systemic fungal infection
  • Metastatic nodule
  • Swelling due to empyema necessitans.
Kyphosis (forward bending of the spine) and Scoliosis (lateral bending of the spine).