Surface anatomy – know your landmarks!

Surface anatomy is key to examination, especially when it comes to percussion and auscultation. Here are some of the major landmarks to guide your examinations:

Heart:

  • The apex of the heart is in the mid-clavicular line, 5th intercostal space. This is where the tricuspid valve is best auscultated
  • The mitral valve should be auscultated at the lower left sternal edge, medial to the apex in the 5th intercostal space
  • The pulmonary valve can auscultated just lateral to the sternum in the left 2nd intercostal space
  • The aortic valve should be auscultated just lateral to the sternum in the right 2nd intercostal space

Lung borders:

  • The apices of the lungs extend 3cm above the mid clavicular point
  • In quiet respiration, the inferior margin of the lungs are:
    • T6 (midclavicular)
    • T8 (midaxillary)
    • T10 posteriorly (median plane)
  • Pleura surface markings two ribs lower

Lung Fissures: 

  • Oblique fissure – T3 to 6th costochondral junction
  • Horizontal fissure – from the oblique fissure in the mid-axillary line to the 4th costal cartilage

Spleen:

  • Marked on left side of the back, with its long axis corresponding with that of 10th rib
  • Upper border corresponds to upper border of 9th rib & lower border to lower border of 11th rib

Liver:

  • The upper surface of the liver is percussed at the level of the fifth intercostal space
  • Lower border is the costal margin

Kidneys:

  • Posteriorly: T11-L3 (Right lower than left)

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