[AS. cest, a box]
The thorax, including all the organs, e.g., heart, great vessels, esophagus, trachea, lungs, and tissues (bone, muscle, fat) that lie between the base of the neck and the diaphragm.
Inspection: The practitioner inspects the chest to determine the respiratory rate and whether the right and left sides of the chest move symmetrically during breathing. In pneumonia, pleurisy, or rib fracture, for example, the affected side of the chest may have reduced movement as a result of lung consolidation or pain (“splinting” of the chest). Increased movements may be seen in extensive trauma (“flail” chest). The patient in respiratory distress uses accessory muscles of the chest to breathe; retractions of the spaces between the ribs are also seen when patients labor to breathe.
Percussion: The chest wall is tapped with the fingers (sometimes with a reflex hammer) to determine whether it has a normally hollow, or resonant, sound and feel. Dullness perceived during percussion may indicate a pleural effusion or underlying pneumonia. Abnormal tympany may be present in conditions such as emphysema, cavitary lung diseases, or pneumothorax.
Palpation: By pressing or squeezing the soft tissues of the chest, bony instability (fractures), abnormal masses (lipomas or other tumors), edema, or subcutaneous air may be detected.
Auscultation: Chest sounds are assessed using the stethoscope. Abnormal friction sounds may indicate pleurisy, pericarditis, or pulmonary embolism; crackles may be detected in pulmonary edema, pneumonia, or interstitial fibrosis; and wheezes may be heard in reactive airway disease. Intestinal sounds heard in the chest may point to diaphragmatic hernias. Heart sounds are diminished in obesity and pericardial effusion; they are best heard near the xiphoid process in emphysema. Lung sounds may be decreased in patients with chronic obstructive lung diseases, pleural effusion, and other conditions.
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