Thoracic and Lung Assessment

Pectus Excavatum

Markedly sunken sternum and adjacent cartilages; congenital chest wall deformity usually causing cosmetic concerns.

Pectus Carinatum

Forward protrusion of the sternum causing adjacent ribs to slope backward.

Pleural Friction Rub

Low-pitched dry grating sound caused by inflamed pleural surfaces rubbing together during inspiration and expiration.

Wheeze (Sibilant)

High-pitched musical sound mainly during expiration caused by air passing through narrowed airways.

Wheeze (Sonorous)

Low-pitched snoring or moaning breath sound caused by obstruction of larger airways.

Fine Crackles

High-pitched short popping sounds during inspiration that do not clear with coughing.

Orthopnea

Shortness of breath when lying flat that improves when sitting or standing.

Crepitus

Crackling sensation caused by air trapped in subcutaneous tissue (subcutaneous emphysema).

Coarse Crackles

Low-pitched moist bubbling sounds heard from early inspiration to early expiration.

Sternal Notch (Jugular Notch)

U-shaped depression at the top of the sternum used as a central thoracic landmark.

Midsternal Line

Vertical line along the sternum used for chest symmetry assessment.

Lateral Sternal Line

Line along the lateral border of the sternum used as a surgical landmark.

Midclavicular Line

Vertical line through the midpoint of the clavicle used in chest assessment and procedures.

Xiphoid Process

Inferior end of the sternum used as a landmark for CPR and thoracic procedures.

Spinous Processes

Bony projections forming the midline of the thoracic spine.

Scapular Line

Vertical line through the inferior angle of the scapula used for posterior chest reference.

Vertebral Line

Posterior median line along the spinous processes.

Anterior Axillary Line

Vertical line along the anterior axillary fold.

Mid-Axillary Line

Vertical line through the apex of the axilla used for auscultation.

Posterior Axillary Line

Vertical line along the posterior axillary fold.

True Ribs

Ribs 1–7 attached directly to the sternum.

False Ribs

Ribs 8–10 attached indirectly to the sternum via costal cartilage.

Floating Ribs

Ribs 11–12 with no anterior attachment.

Manubrium

Upper part of sternum articulating with clavicles and first ribs.

Body of Sternum

Middle part of sternum articulating with ribs 2–7.

Costovertebral Joint

Joint between rib heads and vertebral bodies.

Costotransverse Joint

Joint between rib tubercles and transverse processes.

Vesicular Breath Sounds

Soft low-pitched breezy sounds heard over peripheral lung fields; long inspiration, short expiration.

Bronchovesicular Breath Sounds

Moderate pitch sounds heard between the scapulae and upper sternum; inspiration equals expiration.

Bronchial Breath Sounds

Loud high-pitched tubular sounds heard over the trachea; short inspiration and long expiration.

Fine Crackles (Adventitious)

Late inspiratory popping sounds associated with pneumonia or heart failure.

Coarse Crackles (Adventitious)

Moist bubbling sounds suggesting pulmonary edema or pneumonia.

Pleural Friction Rub (Adventitious)

Dry grating sound caused by inflamed pleural layers rubbing together.

Sibilant Wheeze

High-pitched musical wheeze caused by narrowed airways such as in asthma.

Sonorous Wheeze

Low-pitched snoring sound caused by obstruction of large airways.

Inspection in Thoracic Assessment

Observe chest shape, symmetry, breathing pattern, respiratory rate, and skin color.

Palpation in Thoracic Assessment

Assess tenderness, masses, chest expansion, tactile fremitus, and tracheal position.

Percussion in Thoracic Assessment

Tap chest wall to determine lung density and detect air, fluid, or consolidation.

Auscultation in Thoracic Assessment

Listen to breath sounds using a stethoscope to detect normal and abnormal lung sounds.

Normal Thoracic Inspection Findings

Symmetrical chest with AP-to-transverse ratio 1:2 and respiratory rate 12–20 breaths/min.

Normal Palpation Findings

Warm skin, equal chest expansion, no tenderness, symmetrical tactile fremitus.

Normal Percussion Findings

Resonant sounds over healthy lung tissue.

Normal Auscultation Findings

Vesicular sounds in lung periphery and bronchovesicular sounds over main bronchi.

Abnormal Thoracic Inspection Findings

Barrel chest, cyanosis, spinal deformities, or accessory muscle use.

Abnormal Palpation Findings

Unequal chest expansion, tenderness, crepitus, abnormal tactile fremitus.

Abnormal Percussion Findings

Dullness from fluid or consolidation or hyperresonance from excess air.

Abnormal Auscultation Findings

Adventitious sounds such as crackles, wheezes, rhonchi, or pleural friction rub.

Pneumonia Definition

Acute infection causing inflammation of lung parenchyma.

Chronic Bronchitis Definition

Chronic airway inflammation with productive cough for at least 3 months per year for 2 consecutive years.

Pneumonia Breath Sounds

Crackles, bronchial breath sounds, or decreased breath sounds over affected area.

Chronic Bronchitis Breath Sounds

Rhonchi, wheezing, and prolonged expiration.

Pneumonia Sputum

Rust-colored, purulent, or blood-tinged sputum.

Chronic Bronchitis Sputum

Large amounts of mucopurulent sputum.

Resonance Percussion Note

Low pitch, loud intensity, long duration heard over normal lung tissue.

Hyperresonance Percussion Note

Very loud low-pitched sound indicating excess air.

Tympany Percussion Note

High-pitched drum-like sound heard over air-filled structures.

Dullness Percussion Note

Medium-pitched sound heard over solid organs or fluid-filled areas.

Flatness Percussion Note

High-pitched soft sound heard over very dense tissue such as muscle or bone.

Right Lung Lobes

Upper (superior), middle, and lower (inferior) lobes.

Left Lung Lobes

Upper (superior) and lower (inferior) lobes with lingula.

Right Upper Lobe

Largest upper portion above horizontal fissure with apical, posterior, and anterior segments.

Right Middle Lobe

Smallest right lung lobe between horizontal and oblique fissures.

Right Lower Lobe

Largest lower lung lobe below the oblique fissure responsible for major gas exchange.

Left Upper Lobe

Upper portion containing apicoposterior, anterior, and lingular segments.

Lingula

Tongue-like projection of the left upper lobe.

Left Lower Lobe

Lower portion beneath the oblique fissure containing basal segments.

Ribs

Twelve pairs of curved bones forming the protective thoracic cage.

Intercostal Spaces

Spaces between ribs containing muscles, nerves, and blood vessels.

Locating Intercostal Spaces

Start at the sternal angle where the second rib meets the sternum and count downward.

Before Thoracic Assessment

Explain procedure, obtain consent, wash hands, ensure privacy, position patient upright, and prepare equipment.

During Thoracic Assessment

Inspect chest, palpate structures, percuss lung fields, and auscultate breath sounds.

After Thoracic Assessment

Reposition patient, perform hand hygiene, document findings, and report abnormalities.

Anterior Thorax Inspection

Observe breathing pattern, chest symmetry, deformities, and skin color.

Anterior Thorax Palpation

Check tenderness and chest expansion by placing hands on lower ribs.

Anterior Thorax Percussion

Tap chest wall comparing sides to detect abnormal resonance.

Anterior Thorax Auscultation

Listen systematically from apex to base comparing both lungs.

Posterior Thorax Inspection

Observe back symmetry, spinal alignment, breathing pattern, and skin tone.

Posterior Thorax Palpation

Assess tenderness and chest expansion by placing hands on lower back.

Posterior Thorax Percussion

Tap back comparing lung fields from top to bottom.

Posterior Thorax Auscultation

Listen to breath sounds systematically from apex to base.