PRE-CLINICAL CLERKSHIP, YEAR 1, 2005/2006`
Visible Human Images
Lawrence J. Rizzolo, Ph.D.
1. Learning Objectives
2. Student Prep
Practice Exercises: Identify on the anterior chest of yourself or partner, the sternal angle or angle of Louis (the level of the carina), midclavicular line (MCL), anterior axillary line (AAL), and 4-6th right intercostal spaces (the 4th ICS is at the level of the nipple).
The VH Pro image shows the clavicle and 1st rib (to infer the sternal notch), 2nd rib (to infer the angle of Louis) and the 4th and 6th ribs. The sternum heart and great vessels are omitted.
Use the sliders to add or remove skin, change the angle of rotation, or resize the image. Click <alt-p> on the image to change the cross-section.
On the posterior chest, begin by bending the neck forward to find C7 (vertebra prominens). Outline the upper lobes from T1-T4, and the lower lobes from T4-T10. (To appreciated this point you must rotate the image to distinguish the posterior surfaces of the lung from the rest.)
On the right lateral chest, outline the right middle lobe (RML) between the right 4-6th intercostal spaces.
Listen to the recording of lung sounds on the CD (see your syllabus for details).
3. Clinical Anatomical Landmarks
Sternal angle (angle of Louis)—level of the carina and second rib; 2nd intercostal space is below it
Mid Clavicular Line (MCL)
Right 4th rib (level of nipple and horizontal fissure separating RUL and RML -- rotate image to appreciate this)
Left 6th rib (level of oblique fissure separating LUL and LLL -- rotate image to appreciate this) - look on the axial section to see the inferior-most reach of the upper lobe
Anterior maps for auscultation and percussion
C7 vertebra prominens, and T1
T4 (level of oblique fissure separating UL's and LL's)
Rotate image to appreciate this The axial view shows a hint of the lower lobes posteriorly. Therefore in this patient, the fissure projects a little higher at T3
.............This is just an example of normal anatomical variation
Posterior maps for auscultation and percussion
Posteriorly 12 thoracic vertebrae; areas accessible for evaluations of lung sounds – maps for auscultation and percussion -- will be in the areas between the T-spine and scapulae and below the scapulae
To eyeball where T1 is, have your partner flex his neck and the most prominent vertebral body is C7; T1 is just below it.
For the following discussion, rotate the following images: Upper lobe only, lower lobe only, all lobes
4. List of Maneuvers to be Demo/Practiced See syllabus for details
5. Procedural Tips See syllabus for details
6. Perceptual Tips See syllabus for details
7. Description of Key Features See syllabus for details
©2007 Cheryl Walters, Lawrence Rizzolo, Yale School of Medicine