THE CHEST EXAMINATION
Physical examination of the chest
The chest indicates the region that lies under the neck and above the abdomen. Chest wall is composed of sternum, ribs, and vertebras. The anterior part is a little shorter than the posterior part. Chest examination includes many components: chest shape, chest wall, breasts, vessels, mediastinum, bronchus, lung, pleura, heart, and lymph nodes, etc. In addition to general physical examination, the following check methods have been widely used in clinical work: X-ray topography, lung function test, blood-gas analysis, aetiology, histology, and relevant bio-chemical tests. These methods can provide early stages of abnormality and pathogens, even give out exact diagnosis on pathology and pathogenesis, but, many changes in palpation, percussion and auscultation for all kinds of rales, can not be detected through these methods so they can’t completely replace the basic physical examinations till now. The basic physical examination has long been used clinically, which doesn’t need high-quality equippment, handy for use to provide important information and signs for the diagnosis of the chest diseases. Of course, a correct diagnosis depends not only on the basic physical examination, but also other supplementary examinations and the ill history should be emphasized in synthetical consideration. Traditional physical examination of the chest includes four methods, inspection, palpation, percussion and auscultation. The examination should be performed in warm circumstance with well light. The patient should expose the chest to the full, in sitting or supine position according to the need for the examination or the ill condition, and be examined thoroughly with the sequence of inspection, palpation, percussion and auscultation. In general, the anterior and the lateral part is examined first, then the posterior part, this may overcome the tendency that only percussion and auscultation be cared but inspection and palpation be overlooked and avoid omission of any significant sign. A.. Landmark on chest wall
The chest contains important organs such as lung and heart. Examination of chest aims to determine the physiologic and pathophysiologic situations of these organs. The position of each organ inside the chest can be determined by examining the surface of the chest. To mark the underlying organ, and detect the position and range of the abnormalities, it is quite important to make well aquaintance with the natural landmarks and artificial lines, with which the underlying structure and abnormalities can be exactly located on the chest wall. I Bone landmark
Suprasternal notch: Above the manubrium sterni. In normal condition trachea is in this notch. Manubrium sterni: a piece of hexagon bone at the top of the sternum. Its upper part connects bilaterally to the sternal end of each clavicula, while its base part connects to the sternum. Sternal angle: Also termed Louis angle. It is formed by the protrusion of the conjunction composed of sternum and manabrium sterni. It connects bilaterally to each of the right and left second costal cartilage. It acts as an important landmark for counting rib and interspace, and indicates the bifurcation of the trachea, the upper level of the atria of heart, the demarcation of upper and lower part of mediastinum, and the fifth thoracic vertebra as well. Suprabdominal angle: also termed infrasternal angle, denotes the angle formed by the bilateral rib rows (composed of the seventh to tenth costal cartilage joining bilaterally) which meet at the lower end of the sternum. It corresponds to the dome part of the diaphragm. Normally this angle is approximately 70°- 110°,narrower in slender and wider in dumpy persons, and it also widens slightly during deep inspiration. The underlying region contains the left lobe of liver, stomach and pancreas. Xiphoid process: the protrusive triangular part of the lower end of the...
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