Thorax

• Thorax


  The portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly
• Thoracic cage


  • Constructed of the sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles, and cartilage
• Sternum


  The breastbone that lies in the center of the chest anteriorly, divided into three parts: the manubrium, the body, and the xiphoid process
• Clavicle


  The collar bone that extends from the manubrium to the acromion of the scapula
• Suprasternal notch

  A U-shaped indentation located on the superior border of the manubrium, an important landmark
• Sternal angle

  A bony ridge at the point where the manubrium articulates with the body of the sternum
• Thorax assessment


  1. Inspect for color, intercostal spaces, chest symmetry, respiratory patterns, anterior-posterior to lateral diameter, shape, and position of the sternum, the position of the trachea, and chest expansion

  2. Palpate the posterior chest

  3. Have the client fold arms across the anterior chest and lean forward to increase the area of the lungs

  4. Palpate, percuss, and auscultate the posterior lungs and thorax while the client is sitting

  5. Palpate, percuss and auscultate lateral lungs and thorax while the client is in the supine position
• Assessing thoracic expansion/excursion


  1. Place hands on the posterior thorax at the level of the 10th vertebra, have the client take a deep breath and observe thumb movement

  2. Press skin together at the lower sternum, have the patient take a deep breath and observe thumb movement
• Percussion


  1. Use mediate percussion over shoulder apices and intercostal spaces

  2. Compare both sides for symmetry of percussion notes, moving from apex to base of lungs

  3. Percuss the chest comparing one side with the other at each level using the side-to-side "ladder pattern"
• Auscultation


  1. Auscultate using a diaphragm of a stethoscope, exert firm pressure over intercostal space

  2. Instruct the client to take slow, deep breaths through the mouth

  3. Listen for two full breaths and compare symmetrical sides of the thorax while moving the stethoscope from the apex to the base of the lungs
• Inspection findings


  • Color of lips
  • Intercostal spaces
  • Chest symmetry
  • Respiration patterns
  • Anterior-posterior to lateral diameter
  • Shape and position of sternum
  • Position of trachea
  • Chest expansion
  • Nasal flaring and pursed-lip breathing
  • Color of face, lips, and chest
• Palpation findings


  • Sensation (pain, tenderness)
  • Vocal fremitus
  • Thoracic expansion (posterior)
  • Thoracic expansion (anterior)
• Percussion findings


  • Shoulder apices and intercostal spaces
  • Posterior, diaphragmatic excursions
• Respiration patterns


  • Normal
  • Tachypnea
  • Bradypnea
  • Hyperventilation
  • Hypoventilation
  • Cheyne-Stokes respiration
  • Biot's respiration
• Breath sounds


  • Trachea
  • Large-stem bronchi
  • Lung peripheries
  • Adventitious sounds (crackles, wheezes)
• Altered voice sounds over lung periphery

  • Bronchophony
  • Whispered pectoriloquy
  • Egophony