{"id":1781,"date":"2020-08-17T13:27:38","date_gmt":"2020-08-17T13:27:38","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/surface-projections-relative-dullness-and-chest-radiography\/"},"modified":"2020-12-26T12:12:48","modified_gmt":"2020-12-26T10:12:48","slug":"surface-projections-relative-dullness-and-chest-radiography","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/surface-projections-relative-dullness-and-chest-radiography\/","title":{"rendered":"Surface Projections, Relative Dullness, and Chest Radiography"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Surface projections of the heart<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ol class=\"wp-block-list\"><li><strong>Apex<\/strong>&nbsp;\u2014 5th intercostal space 8-10 cm to left relative to the midline, or can be either left 5th intercostal space 1-2 cm medial to the midclavicular line (imaginary line crosses vertically to the clavicle), the second position is also the position for palpation of the apex beat, called punctum maximum, or the point of maximum impulse (PMI)<\/li><li><strong>Right coronary groove<\/strong>&nbsp;\u20132cm 6th costal cartilage lateral to the sternal at the right side<\/li><li><strong>Left coronary groove<\/strong>&nbsp;\u2014 3rd costal cartilage 3cm to the left laterally to the sternum<\/li><li><strong>SVC drainage into the right atrium<\/strong>&nbsp;\u2013right 3rd costal cartilage at the parasternal line<\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Valves \u2014 Locations for auscultation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">During routine examinations, the physician can listen to different parts of the cardiovascular system using a stethoscope.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following locations are used for listening to the heart sounds (or more accurately the closing and opening of the cardiac valves, and are referred to as the&nbsp;<strong>punctum maximum&nbsp;<\/strong>\u2014 latin for maximal impulse):<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Aortic valve<\/strong>\u00a0\u2014 Right 2nd intercostal space 2cm parasternally<\/li><li><strong>Pulmonary trunk<\/strong>\u00a0\u2014 Left 2nd intercostal space parasternally<ul><li>The most superficial valve (closest to the chest wall)<\/li><\/ul><\/li><li><strong>Tricuspid valve<\/strong>\u00a0\u2014 Right 4th intercostal space parasternally, another way to find the tricuspid is at the left 4-5th intercostal space parasternally<\/li><li><strong>Bicuspid (Mitral) valve<\/strong>\u00a0\u2014\u00a0 Left 5th intercostal space 1-2 cm medial to the midclavicular line (8-10 cm from midline)<ul><li>The deepest valve<\/li><\/ul><\/li><\/ol>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"970\" src=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/heart-auscultation-1024x970.png\" alt=\"\" class=\"wp-image-3021\" srcset=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/heart-auscultation-1024x970.png 1024w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/heart-auscultation-300x284.png 300w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/heart-auscultation-768x727.png 768w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/heart-auscultation.png 1266w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><strong>Figure 1. Auscultation points of the heart<\/strong><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"744\" height=\"1024\" src=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/auscultation-points-744x1024.png\" alt=\"\" class=\"wp-image-3022\" srcset=\"https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/auscultation-points-744x1024.png 744w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/auscultation-points-218x300.png 218w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/auscultation-points-768x1057.png 768w, https:\/\/meddists.com\/learn\/wp-content\/uploads\/2020\/12\/auscultation-points.png 872w\" sizes=\"auto, (max-width: 744px) 100vw, 744px\" \/><figcaption><strong>Figure 2. Auscultation points of the heart<\/strong>; <br><strong>Blue&nbsp;<\/strong>\u2014 Aortic valve<br><strong>Yellow<\/strong>&nbsp;\u2014 Pulmonary valve<br><strong>Rad<\/strong>&nbsp;\u2014 Tricuspid valve<br><strong>Green<\/strong>&nbsp;\u2014 Mitral valve<br><strong>Light blue<\/strong>&nbsp;\u2014&nbsp;<strong>Erb\u2019s point<\/strong>&nbsp;(refers to the third intercostal space on the left sternal border)<\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">The dullness of the heart<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The physician can determine the location, size, and density of the heart and nearby structures by tapping on the patient\u2019s chest.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is called&nbsp;<strong>percussion<\/strong>, a procedure in which&nbsp;vibrations are produced within the chest (or any other part of the body which is being percussed).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>During the procedure, the physician listens in an attempt to hear differences in soundwave conduction formed by the density differences of the different tissues; therefore, in order to identify the different tissues correctly, the physician should avoid tapping the bones<\/li><li>There can be 3 types of resonance sounds:<ul><li><strong>Absolute dullness<\/strong>&nbsp;\u2014 Where the heart is not covered by the lungs. 4-5 intercostal spaces 2-3 cm to the left at the para-sternal line (between the sternal and mid-clavicular lines) indicate the central mass of the heart<\/li><li><strong>Relative dullness<\/strong>&nbsp;\u2014 Where the heart is covered by the left lung (lingula), left to the absolute dullness location. The right lung also covers part of the heart; however, this area is found posterior to the sternum and it\u2019s not possible to determine using percussion<\/li><li><strong>Resonant, non-tympanic sounds&nbsp;<\/strong>\u2014 Lungs<\/li><\/ul><\/li><li>Percussion of the lungs will produce a hollow, deep, resonating sound, while denser tissues (such as the relative dullness point) will produce a less resonating sound. The absolute dullness point will emit the least resonating sounds<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"http:\/\/meddists.com\/wp-content\/uploads\/2018\/10\/lower-borders-of-the-heart.png\" alt=\"\" class=\"wp-image-7516\"\/><figcaption><strong>Figure 3. The position of the heart within the thorax<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">The figure above illustrates how to find the&nbsp;<strong>lower border of the right lung<\/strong>, the&nbsp;<strong>hepatic dullness<\/strong>&nbsp;and<strong>&nbsp;the lower border of the heart<\/strong>. All you need to do is move along the midclavicular line until you reached the 6th rib \u2014 that\u2019s where you will find the lower border of the right lung.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>At the&nbsp;<strong>6th intercostal space<\/strong>, you will observe different resonance, at this position you will find the upper border of the liver \u2014&nbsp;<strong>hepatic dullness<\/strong><\/li><li>In order to find the<strong>&nbsp;lower border of the heart<\/strong>, we need to move from the&nbsp;<strong>6th rib<\/strong>&nbsp;towards the left side until we will reach the<strong>&nbsp;5th intercostal space 1-2 cm<\/strong>&nbsp;to the left from the&nbsp;<strong>parasternal line<\/strong>&nbsp;or&nbsp;<strong>8-10 cm from the midline<\/strong><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"http:\/\/meddists.com\/wp-content\/uploads\/2018\/10\/Dullness-of-the-heart-1.png\" alt=\"\" class=\"wp-image-7517\"\/><figcaption>&nbsp;<strong>Figure 4. The position of the heart within the thorax<\/strong><\/figcaption><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">The figure above illustrates how to find the right border of the heart, the upper border of the heart and the left border of the heart.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In order to find the<strong>&nbsp;right border of the heart<\/strong>&nbsp;we need to move along the anterior axillary line until the 5th rib, then move medially until the sound become non-tympanic, and does not change until the sternal edge indicating the heart surface<\/li><li>In order to find the&nbsp;<strong>Left border of the heart<\/strong>, we need to move along the mid-axillary line until the 5th intercostal space, move then medially to the location of the apex (1-2 cm from the parasternal line or 8-10 cm from the midline)<\/li><li>In order to find the&nbsp;<strong>upper border of the heart<\/strong>, we will move along the parasternal line until the 3rd intercostal space where we will observe different sound- the upper border of the heart<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Chest X-ray<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">In some universities, it is required to know and identify parts of the heart in an&nbsp;X-ray image. Here are the most important components you should know.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"http:\/\/meddists.com\/wp-content\/uploads\/2018\/09\/1920px-Mediastinal_structures_on_chest_X-ray_annotated.jpg\" alt=\"\" class=\"wp-image-5479\"\/><figcaption><strong>Figure 5. Illustration of the heart on chest X-ray<\/strong>&nbsp;\u2014 Adapted from the work of Mikael H\u00e4ggstr\u00f6m \u2014&nbsp;CC BY-SA 3.0<\/figcaption><\/figure><\/div>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"http:\/\/meddists.com\/wp-content\/uploads\/2018\/09\/Anterior-xray-labled.jpeg\" alt=\"\" class=\"wp-image-5480\"\/><figcaption><strong>Figure 6. Labeled chest X-ray<\/strong><\/figcaption><\/figure>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Surface projections of the heart<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Valves \u2014 Locations for auscultation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">The dullness of the heart<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Chest X-ray<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Surface projections of the heart Apex&nbsp;\u2014 5th intercostal space 8-10 cm to left relative to the midline, or can be either left 5th intercostal space 1-2 cm medial to the midclavicular line (imaginary line crosses vertically to the clavicle), the second position is also the position for palpation of the apex beat, called punctum maximum, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1773,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1781","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Surface Projections, Relative Dullness, and Chest Radiography &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/surface-projections-relative-dullness-and-chest-radiography\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/\",\"name\":\"Surface Projections, Relative Dullness, and Chest Radiography &#8211; Meddists\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/meddists.com\\\/learn\\\/wp-content\\\/uploads\\\/2020\\\/12\\\/heart-auscultation-1024x970.png\",\"datePublished\":\"2020-08-17T13:27:38+00:00\",\"dateModified\":\"2020-12-26T10:12:48+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/anatomy\\\/thorax\\\/heart\\\/surface-projections-relative-dullness-and-chest-radiography\\\/#primaryimage\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/wp-content\\\/uploads\\\/2020\\\/12\\\/heart-auscultation.png\",\"contentUrl\":\"https:\\\/\\\/meddists.com\\\/learn\\\/wp-content\\\/uploads\\\/2020\\\/12\\\/heart-auscultation.png\",\"width\":1266,\"height\":1199,\"caption\":\"Figure 1. 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Auscultation points of the heart"},{"@type":"BreadcrumbList","@id":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/surface-projections-relative-dullness-and-chest-radiography\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/meddists.com\/learn\/"},{"@type":"ListItem","position":2,"name":"Pre-clinical","item":"https:\/\/meddists.com\/learn\/pre-clinical\/"},{"@type":"ListItem","position":3,"name":"Anatomy","item":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/"},{"@type":"ListItem","position":4,"name":"Thorax","item":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/"},{"@type":"ListItem","position":5,"name":"Heart","item":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/thorax\/heart\/"},{"@type":"ListItem","position":6,"name":"Surface Projections, Relative Dullness, and Chest Radiography"}]},{"@type":"WebSite","@id":"https:\/\/meddists.com\/learn\/#website","url":"https:\/\/meddists.com\/learn\/","name":"Meddists","description":"Let&#039;s Get Studying","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/meddists.com\/learn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/1781","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/comments?post=1781"}],"version-history":[{"count":6,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/1781\/revisions"}],"predecessor-version":[{"id":3422,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/1781\/revisions\/3422"}],"up":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/1773"}],"wp:attachment":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/media?parent=1781"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}