Thursday, July 8, 2021 6:22 PM
The number of intercostal space between 2 ribs is the
same number above it
Angle of louis 5 cm below sternal notch
( sternal angle )
2nd rib Exactly adjacent to sternal angle
2nd intercostal space Needle insertion for tension pneumothorax always second person is free of tense
4th intercostal space Chest tube insertion fortube
T4 Lower margin of endotracheal tube on chest X ray
First 7 ribs Their costal cartilage articulate with sternum
8th,9th,10th ribs Their costal cartilage articulate with one above them
Inferior angle of scapula 7th rib, 7th intercostal space
If 2 spinous processes are equally then they are C7 ;T1
prominent during flexion forward
Thoracentesis Its landmark is T7-T8 intercostal space Needle inserted immediately superior to 8th rib
Apex of lung 2-4cm above inner third of clavicle
Lower border of lung Crosses 6th rib at midclavicular line Crosses 8th rib at midaxillary line
Lower border of lung T10 Spinous Process
(Posteriorly)
Horizontal Fissure Between RUL and RML 1. Starts anteriorly from 4th rib
2. Meets oblique fissure in midaxillary line near 5th rib
Supraclavicular Above clavicle
infraclavicular Below clavicle
interscapular Between scapula
infrascapular Below scapula
Base of lungs Lowermost portions
Aspiration Pneumonia Common in : REASON = right main bronchus is more vertical. So
• RML objects can enter easily here
• RLL
Pleural effusion Dull sound by percussion
Pleural effusion If fluid is transudate We will see it in:
• Heart failure
• Cirrhosis
• nephrotic syndrome
Pleural effusion If fluid is exudate We will see it in :
• Pneumonia
• Malignancy
• Pulmonary embolism
• Tuberculosis
• pancreatitis
Irritation of parietal pleura Produces pleuritic pain with deep inspiration With patients who have :
• Viral pleurisy
• Pneumonia
• Pulmonary embolism
• Pericarditis
• Collagen vascular disease
Hemoptysis Blood-Streaked sputum
To diagnose chest pain Always investigate with both:
• Thoracic causes
• Cardiac causes
Source of chest pain = Related causes=
myocardium • Angina pectoris
• Myocardial infarction
• myocarditis
Source of chest pain= Related cause=
pericardium • Pericarditis
Source of chest pain = Related cause=
aorta • Aortic dissection
Source of chest pain= Related cause=
Trachea+ large bronchi • Bronchitis
Source of chest pain= Related cause=
Parietal pleura • Pericarditis
• Pneumonia
• Pneumothorax
• Pleural effusion
• Pulmonary embolism
Source of chest pain= Related cause=
Chest wall, including musculoskeletal • Costochondritis
+ neurologic systems • Herpes zoster
Source of chest pain= Related cause=
esophagus • Gastroesophageal reflux disease
• Esophageal spasm
• Esophageal tear
The number of intercostal space between 2 ribs is the
same number above it
Angle of louis 5 cm below sternal notch
( sternal angle )
2nd rib Exactly adjacent to sternal angle
2nd intercostal space Needle insertion for tension pneumothorax always second person is free of tense
4th intercostal space Chest tube insertion fortube
T4 Lower margin of endotracheal tube on chest X ray
First 7 ribs Their costal cartilage articulate with sternum
8th,9th,10th ribs Their costal cartilage articulate with one above them
Inferior angle of scapula 7th rib, 7th intercostal space
If 2 spinous processes are equally then they are C7 ;T1
prominent during flexion forward
Thoracentesis Its landmark is T7-T8 intercostal space Needle inserted immediately superior to 8th rib
Apex of lung 2-4cm above inner third of clavicle
Lower border of lung Crosses 6th rib at midclavicular line Crosses 8th rib at midaxillary line
Lower border of lung T10 Spinous Process
(Posteriorly)
Horizontal Fissure Between RUL and RML 1. Starts anteriorly from 4th rib
2. Meets oblique fissure in midaxillary line near 5th rib
Supraclavicular Above clavicle
infraclavicular Below clavicle
interscapular Between scapula
infrascapular Below scapula
Base of lungs Lowermost portions
Aspiration Pneumonia Common in : REASON = right main bronchus is more vertical. So
• RML objects can enter easily here
• RLL
Pleural effusion Dull sound by percussion
Pleural effusion If fluid is transudate We will see it in:
• Heart failure
• Cirrhosis
• nephrotic syndrome
Pleural effusion If fluid is exudate We will see it in :
• Pneumonia
• Malignancy
• Pulmonary embolism
• Tuberculosis
• pancreatitis
Irritation of parietal pleura Produces pleuritic pain with deep inspiration With patients who have :
• Viral pleurisy
• Pneumonia
• Pulmonary embolism
• Pericarditis
• Collagen vascular disease
Hemoptysis Blood-Streaked sputum
To diagnose chest pain Always investigate with both:
• Thoracic causes
• Cardiac causes
Source of chest pain = Related causes=
myocardium • Angina pectoris
• Myocardial infarction
• myocarditis
Source of chest pain= Related cause=
pericardium • Pericarditis
Source of chest pain = Related cause=
aorta • Aortic dissection
Source of chest pain= Related cause=
Trachea+ large bronchi • Bronchitis
Source of chest pain= Related cause=
Parietal pleura • Pericarditis
• Pneumonia
• Pneumothorax
• Pleural effusion
• Pulmonary embolism
Source of chest pain= Related cause=
Chest wall, including musculoskeletal • Costochondritis
+ neurologic systems • Herpes zoster
Source of chest pain= Related cause=
esophagus • Gastroesophageal reflux disease
• Esophageal spasm
• Esophageal tear
