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Section VI: Pulmonary

Anatomy

Upper Respiratory Tract

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Trachea and Bronchial Tree

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Anterior View of Lungs and Thorax

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Posterior View of Lungs and Thorax

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Normal posteroanterior (PA) chest radiograph.

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Anatomy of the Bronchopulmonary Tree

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Examination

Terms Associated With the Examination of the Pulmonary System

barrel chest: An increased anterior-posterior diameter of the thorax, barrel chest is sometimes associated with pulmonary emphysema.

cyanosis: A bluish tinge to the skin, cyanosis is caused by low oxygen saturation of hemoglobin.

digital clubbing: An abnormal finding, digital clubbing is flattening of the normal angle between the base of the nail and its cuticle as well as enlargement of the terminal phalanx.

flail chest: When ribs are broken in two or more places, this segment of the chest wall moves paradoxically during ventilation.

fremitus: Palpable vibrations felt through the chest wall (see tactile fremitus and vocal fremitus).

palpation: The chest is palpated for areas of tenderness, symmetry, amount, and synchrony of thoracic excursion during ventilation, integrity of the rib cage, and position of the mediastinum and vibrations.

pectus carinatum: The sternum protrudes forward and is abnormally prominent; also called pigeon or chicken breast.

pectus excavatum: The sternum is abnormally depressed; it is also called funnel chest.

percussion: See separate listing on Abnormal Breath Sounds below.

tactile fremitus: Palpable vibrations are felt during ventilation. (See fremitus and vocal fremitus.)

vocal fremitus: Palpable felt vibrations when the patient is speaking. (See fremitus and tactile fremitus.)

TABLE 6.1Terms Used to Describe Breathing
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TABLE 6.1 Terms Used to Describe Breathing
Term Explanation
Apnea Absence of breathing
Apneusis Cessation of respiration in the inspiratory position
Biot's breathing Several short breaths or gasps followed by irregular periods of apnea
Bradypnea Abnormally slow rate of breathing
Cheyne-Stokes respiration Cycles of gradual increase in rate and depth of respiration with apneic pauses between cycles
Dyspnea Complaint of shortness of breath
Eupnea Normal rate and rhythm of breathing
Hyperpnea Increased breathing; increased depth with or without increased rate
Hyperventilation Increased ventilation; technically a decrease in PaCO2
Hypoventilation Decreased ventilation; technically an increase in PaCO2
Kussmaul's breathing Deep gasping respirations associated with diabetic acidosis and coma ("air hunger")
Orthopnea Dyspnea that occurs when patient assumes recumbent position
Paroxysmal nocturnal dyspnea Dyspnea that comes on at night and suddenly awakens the patient
Tachypnea Abnormally rapid rate of breathing

Respiratory Rate

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