① Thoracic examination.

Normal thorax: both sides are roughly symmetrical; both shoulders and the lower angles of both shoulder blades are at the same level. The anteroposterior diameter of the adult thorax is smaller than the transverse diameter and is oblate in shape. The infant's thorax is approximately round. The chest of the elderly is slightly barrel-shaped. In general, the upper angle of the abdomen is almost a right angle. For short and fat people, the angle is larger, while for slim people, the angle is smaller.

Abnormal chest: including barrel chest, flat chest, pectus carinatum, pectus excavatum and local depression of the chest.

Barrel chest means that all diameters of the thoracic cage are enlarged, but the increase in the anterior and posterior diameters is obvious, the ribs are lifted up to a horizontal position, the intercostal space is widened, the upper and lower fossae of the clavicle are flattened or protruded, and the upper and lower abdominal fossae are flattened or protruded. The angle is obtuse, and the thoracic vertebrae are obviously protruding backward, giving the thorax a barrel shape. Commonly seen in emphysema, bronchial asthma attacks and the elderly.

Flat chest refers to a small front-to-back diameter, less than half of the transverse diameter, a flat shape, little subcutaneous fat, poor muscle development, clear intercostal spaces, sunken supraclavicular fossae, sharp upper abdominal corners, and neck The head and chest are slender. Common in wasting diseases such as tuberculosis.

Chicken breast refers to the enlargement of the anteroposterior diameter of the thorax, the reduction of the transverse diameter, and the forward protrusion of the middle and lower sections of the sternum, resembling a chicken breast. The joints between ribs and costal cartilage become thickened, enlarged and have bead-like protrusions, which is a characteristic of rickets.

Funimentum excavatum is relatively rare, with retraction of the xiphoid process of the lower part of the sternum and the lower edge of the ribs. It is more common in congenital developmental abnormalities or rickets.

Local depression of the thorax refers to unilateral or localized depression of the thorax, which can be seen in atelectasis, lung atrophy, pleural adhesions, etc.

②Chest wall examination.

Chest wall veins: The chest wall veins are not obvious in normal people. In lactating women, the subcutaneous veins near the breasts may be more obvious. After the superior or inferior vena cava return is blocked, the veins are formed due to the formation of collateral circulation. Chest wall veins are engorged, dilated, or tortuous.

Chest wall tenderness: Gently press each part of the chest wall with your hands and pay attention to whether there is tenderness. Normal people have no tenderness. Chest wall tenderness is seen in rib fractures, costochondritis, intercostal neuralgia, and herpes zoster. Leukemia patients have bone tenderness.

Subcutaneous emphysema of the chest wall: The presence of air under the skin of the chest wall is called subcutaneous emphysema. It has a swollen appearance and a special feeling when palpated. It is common in lung tissue rupture and trauma.

Breasts: Pay attention to whether they are symmetrical, whether the nipples on both sides are at the same level, whether there is invagination, bulge, discharge, scaling, cracks or erosion, whether the breast skin is red, orange peel-like, or Ulceration and nodularity, and attention should be paid to whether there are masses, the number, size, shape, boundaries, hardness, compression, and mobility of the masses, and whether there are adhesion to the surrounding tissue and skin.