Interactive Guide to Physical Examination
Thorax & Lungs

Examination of the Thorax and Lungs

Objectives:

After completing this module, the student should be able to recognize and describe:

  • Topographical anatomy of the thorax and lungs.
  • Physical exam findings in relationship to a set of imaginary lines drawn around the thorax.
  • Examination techniques used in inspection, palpation, percussion and auscultation of the thorax.
  • Advanced examination techniques used to evaluate pulmonary pathology.

Module navigation:

Ideally, the student should progress through the module by using the menu of options on the left side. Cues to access the glossary, video clips, or interactive portions of the module can be found within the text.

Equipment needed:

  • Stethoscope with bell (for low pitched sounds) and diaphragm, (for high pitched sounds), with approximately 12-inch long tubing.
  • Pen and tape measure.

General approach to the thoracic examination:

Thorough evaluation of the thorax and lungs is an essential component of a complete physical examination. The traditional systematic approach involves inspection, followed by palpation, percussion and then auscultation of both the anterior, lateral, and posterior thorax. The experienced clinician may vary the order or use advanced techniques to further characterize abnormal findings.

The posterior thorax is best examined with the patient sitting upright, arms folded across the chest, and hands placed on opposite shoulders. This displaces the scapulae laterally and exposes more pulmonary parenchyma to the examiner's hands and ears. Patients unable to sit upright should be assisted to do so; alternatively, the examination may be conducted while the patient is lying on his side. The anterior thorax may be examined while the patient is either upright or supine.

Always compare one side to the other (thus having the patient serve as his or her own control), and apices to bases. No portion of the exam should be conducted through clothing.