Displacement of apical impulse is seen in push and pull of the pleuropulmonary disease
Inspection for shape and movement of the chest
Crowding of ribs
Patient should be in sitting or standing posture
Crowding of ribs should be made out from the back
Standing behind the patient by sliding the fingers along the lower intercostal spaces on either sides and comparing them
Supraclavicular and Infraclavicular fossa
Supraclavicular and Infraclavicular fossa hollowing is seen following
- Fibrosis
- Collapse of the lung,
- Malnutrition
It is seen in
- Fibrosis
- Collapse of lung
Movement of the Chest-It is described in terms of rate, rhythm ,equality and type of breathing.
The skin over the chest wall
The skin over the chest wall is examined for the following:
- Engorged veins and subcutaneous nodules seen in sarcoid and malignancy
- Intercostal scar are drained pleural effusion, empyema or pneumothorax
- Discharging sinuses is seen in Tuberculosis
- Empyema necessitans in which there is an intercostal swelling is seen close to the sternum.
- Metastatic nodule
- Swelling due to empyema necessitans.
Presence of Veins over the chest wall
In superior vena caval syndrome look for presence of distended veins over the chest wall
If the obstruction to SVC occur above the level of azygos vein, collateral venous circulation on the anterior surface of chest wall is less prominent as the intercostal veins drain into the azygos vein.
If the obstruction to SVC is at or below the level of azygos vein, collateral veins on the chest become prominent as these collaterals carry blood caudally to the IVC.
Common causes of intercostal suction
Following are the common causes of intercostalsuction
- Foreign body wiihin larynx or trachea.
- Diphtheria.
- Oedema of the glottis (in anaphylaxis).
- COPD.
- Bronchiolitis (in infants and children).
- Bilateral diaphragmatic palsy.
