Physical Examination of the Lungs- Trauma to the Lungs-Surgical Access to the Lungs

Physical Examination of the Lungs

For physical examination of the patient, it is helpful to remember that the upper lobes of the lungs are most easily examined from the front of the chest and the lower lobes from the back. In the axillae, areas of all lobes can be examined

Trauma to the Lungs

A physician must always remember that the apex of the lung projects up into the neck (1 in. [2.5 cm] above the clavicle) and can be damaged by stab or bullet wounds in this area. Although the lungs are well protected by the bony thoracic cage, a splinter from a fractured rib can nevertheless penetrate the lung, and air can escape into the pleural cavity, causing a pneumothorax and collapse of the lung. It can also find its way into the lung connective tissue. From there, the air moves under the visceral pleura until it reaches the lung root. It then passes into the mediastinum and up to the neck. Here, it may distend the subcutaneous tissue, a condition known as subcutaneous emphysema. The changes in the position of the thoracic and upper abdominal viscera and the level of the diaphragm during different phases of respiration relative to the chest wall are of considerable clinical importance. A penetrating wound in the lower part of the chest may or may not damage abdominal viscera, depending on the phase of respiration at the time of injury.

Surgical Access to the Lungs

Surgical access to the lung or mediastinum is commonly undertaken through an intercostal space , Special rib retractors that allow the ribs to be widely separated are used. The costal cartilages are sufficiently elastic to permit considerable bending. Good exposure of the lungs is obtained by this method.