chest
(chĕst 
)
[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.
Physical Examination: 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.
barrel c.An increased anteroposterior chest diameter caused by increased functional residual capacity, which in turn results from airway narrowing and a loss of lung elasticity. It is most often seen in patients with chronic obstructive pulmonary disease, i.e., chronic bronchitis and emphysema.
emphysematous c.A misnomer for the barrel-shaped appearance of the chest in emphysema. The thorax is short and round, the anteroposterior diameter is often as long as the transverse diameter, the ribs are horizontal, and the angle formed by divergence of the costal margin from the sternum is obtuse or obliterated.
flail c.A condition of the chest wall due to two or more fractures on each affected rib resulting in a segment of rib not attached on either end; the flail segment moves paradoxically in with inspiration and out during expiration.
flat c.A deformity of the chest in which the anteroposterior diameter is short, the thorax long and flat, and the ribs oblique. The scapula is prominent; the spaces above and below the clavicles are depressed. The angle formed by divergence of the costal margins from the sternum is very acute.
pigeon c.A condition in which the sides of the chest are considerably flattened and the sternum is prominent. The sternal ends of the ribs are enlarged or beaded. Often there is a circular construction of the thorax at the level of the xiphoid cartilage. The condition is often congenital and present in mucopolysaccharidoses. SYN: pectus carinatum.