Lines of Reference
  • Anterior:
    Midsternal Line (MSL)
    Left sternal border (LSB)
    Right sternal border (RSB)
    Midclavicular Lines (MCL)
  • Lateral
    Anterior Axillary Lines (AAL)
    Mid Axillary Lines (MAL)
    Posterior Axillary Lines (PAL)
  • Posterior
    Vertebral Line (VL)
    Right Scapular Line (RSL)
    Left Scapular Line (LSL)

    Landmarks
  • Sternal angle: (Louis' angle) Anterior end of the 2nd rib, is the level of the tracheal bifurcation and cardiac atria.
  • Vertebra prominens: (7th cervical) Base of the neck, post ribs.
  • Dome of diaphragm: Level of 5th rib on the right, 1 inch lower on the left.

    Respiration
    Symmetry
  • Asymmetries
    Shape & Volume
  • Pectum excavatum (funnel chest)
  • Pectum carinatum (pigeon's breast)
  • Barrel-shaped (emphysema)
    Surface
  • Retraction/bulging of Intercostal spaces (ICS).
  • Broadbent's sign: Retraction of left ICS in adhesive pericarditis.
    Spine Estimate shape and movements.
    Normal curvatures:
    Kyphosis (accentuated anteroposterior curvature of the spine, hunchback).
    Scoliosis (lateral curvature of the spine). Lordosis (lumbo-sachral spine is abnormally straight, poker-spine).

  • Soft Tissues
  • Crepitation
  • Muscular bulk
  • Supraclavicular pulses

  • Ribs and Spine
  • Lymph nodes (see Breast exam)