Comprehensive Chest and Lung
Examination Key Findings
I. Normal Findings in Adults
A. Chest Shape and Movement
Anteroposterior (AP) Diameter vs. Transverse Diameter: The normal AP
diameter is approximately half (0.5) of the transverse diameter.
Chest Movement (Inspection): Expect bilaterally symmetric chest
expansion during respiration.
B. Palpation
Thoracic Muscles and Skeleton:
o Rib cage elasticity: The rib cage should demonstrate normal
elasticity upon palpation.
o Sternum: The sternum should feel inflexible.
o Thoracic spine: The thoracic spine should feel rigid.
Trachea:
o The trachea should be midline directly above the suprasternal
notch.
o There should be equal space on either side of the trachea.
o A slight deviation to the right can be a normal finding in some
individuals.
Tactile Fremitus: A normal finding is bilateral symmetry in the quality of
tactile fremitus.
Ribs: Normal palpation reveals elasticity of the ribs.
Sternum: Normal palpation reveals inflexibility of the sternum.
C. Percussion
Lung Sounds: The normal sound associated with percussion of the lungs is
resonance.
Diaphragmatic Excursion: A normal excursion distance falls between 3
and 5 cm. When comparing both sides, the diaphragm is typically higher
on the right side.
Percussion Tone:
o Over lung tissue (anterior view): Resonance is expected.
, o Over areas like bone: Flatness is expected.
D. Auscultation
Normal Breath Sounds:
o Tracheal: High-pitched, high-intensity sounds heard over the
trachea.
o Bronchial (Bronchotracheal): High pitch with loud and long
expirations.
o Bronchovesicular: Medium pitch; expiration equals inspiration;
typically heard over the bronchi.
o Vesicular: Low-pitch with soft and short expirations; typically heard
over the peripheral lung tissue.
E. Respiratory Rate
The expected rate for a healthy adult is 12 to 20 respirations per minute.
F. Tracing of Normal Breath Sounds (Inspection)
A = regular and comfortable at 12 - 20 rpm.
II. Normal Findings in Newborns and Children
A. Newborns
Normal Respiratory Findings:
o Sneezing
o Paradoxical breathing (abdomen rises while chest falls, and vice
versa)
o Diaphragmatic breathing
o Respiratory rate of approximately 50 breaths per minute.
o Acrocyanosis (bluish discoloration of hands and feet) is considered a
normal finding in the immediate newborn period.
Chest Circumference: A full-term baby with a head circumference of 36
cm would be expected to have a chest circumference between 33 and 34 cm.
Respiration Rate: Approximately 60 rpm.
B. Children
Examination Key Findings
I. Normal Findings in Adults
A. Chest Shape and Movement
Anteroposterior (AP) Diameter vs. Transverse Diameter: The normal AP
diameter is approximately half (0.5) of the transverse diameter.
Chest Movement (Inspection): Expect bilaterally symmetric chest
expansion during respiration.
B. Palpation
Thoracic Muscles and Skeleton:
o Rib cage elasticity: The rib cage should demonstrate normal
elasticity upon palpation.
o Sternum: The sternum should feel inflexible.
o Thoracic spine: The thoracic spine should feel rigid.
Trachea:
o The trachea should be midline directly above the suprasternal
notch.
o There should be equal space on either side of the trachea.
o A slight deviation to the right can be a normal finding in some
individuals.
Tactile Fremitus: A normal finding is bilateral symmetry in the quality of
tactile fremitus.
Ribs: Normal palpation reveals elasticity of the ribs.
Sternum: Normal palpation reveals inflexibility of the sternum.
C. Percussion
Lung Sounds: The normal sound associated with percussion of the lungs is
resonance.
Diaphragmatic Excursion: A normal excursion distance falls between 3
and 5 cm. When comparing both sides, the diaphragm is typically higher
on the right side.
Percussion Tone:
o Over lung tissue (anterior view): Resonance is expected.
, o Over areas like bone: Flatness is expected.
D. Auscultation
Normal Breath Sounds:
o Tracheal: High-pitched, high-intensity sounds heard over the
trachea.
o Bronchial (Bronchotracheal): High pitch with loud and long
expirations.
o Bronchovesicular: Medium pitch; expiration equals inspiration;
typically heard over the bronchi.
o Vesicular: Low-pitch with soft and short expirations; typically heard
over the peripheral lung tissue.
E. Respiratory Rate
The expected rate for a healthy adult is 12 to 20 respirations per minute.
F. Tracing of Normal Breath Sounds (Inspection)
A = regular and comfortable at 12 - 20 rpm.
II. Normal Findings in Newborns and Children
A. Newborns
Normal Respiratory Findings:
o Sneezing
o Paradoxical breathing (abdomen rises while chest falls, and vice
versa)
o Diaphragmatic breathing
o Respiratory rate of approximately 50 breaths per minute.
o Acrocyanosis (bluish discoloration of hands and feet) is considered a
normal finding in the immediate newborn period.
Chest Circumference: A full-term baby with a head circumference of 36
cm would be expected to have a chest circumference between 33 and 34 cm.
Respiration Rate: Approximately 60 rpm.
B. Children
