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Figure 13-3 Thoracic cage landmarks. A, Topographic landmarks of the anterior thorax. B, Landmarks on the lateral view.

Figure 13-4 Topographic landmarks of the posterior thorax.

Figure 13-3 Thoracic cage landmarks. A, Topographic landmarks of the anterior thorax. B, Landmarks on the lateral view.

Spinous process of C7

Scapula lines

Midspinal line

Spinous process of C7

Scapula lines

Midspinal line

Right middle lobe

Horizontal fissure

Right upper lobe

Right middle lobe

Horizontal fissure

Right upper lobe

Left upper lobe Left oblique fissure

Left lower lobe

Spinous process of C7

Left upper lobe Left oblique fissure

Left lower lobe

Right lower lobe

Right oblique fissure A Spinous process of T3

Spinous process of C7

Left upper lobe

Right oblique fissure Horizontal fissure

Left upper lobe

Left lower lobe

Right oblique fissure Horizontal fissure

Right upper lobe

Right upper lobe

Right lower lobe

Right oblique fissure A Spinous process of T3

Left lower lobe

Right lower lobe

Figure 13-5 Surface topography and the underlying interlobar fissures. A, Anterior view. B, Posterior view. C, Lateral view.

The interlobar fissures, illustrated in Figure 13-5, are situated between the lobes of the lungs. Both the right and the left lungs have an oblique fissure, which begins on the anterior chest at the level of the sixth rib at the midclavicular line and extends laterally upward to the fifth rib in the midaxillary line, ending at the posterior chest at the spinous process of T3. The right lower lobe is below the right oblique fissure;the right upper and middle lobes are superior to the right oblique fissure. The left lower lobe is below the left oblique fissure;the left upper lobe is superior to the left oblique fissure. The horizontal fissure is present only on the right and divides the right upper lobe from the right middle lobe. It extends from the fourth rib at the sternal border to the fifth rib at the midaxillary line.

The lungs extend superiorly about 3 to 4 cm above the medial end of the clavicles. The inferior margins of the lungs extend to the sixth rib at the midclavicular line, to the eighth rib at the midaxillary line, and between T9 and T12 posteriorly. This variation is related to respiration. The bifurcation of the trachea, the carina, is located behind the angle of Louis at approximately the level of T4 on the posterior chest. The right hemidiaphragm at the end of expiration is located at the level of the fifth rib anteriorly and T9 posteriorly. The presence of the liver on the right side makes the right hemidiaphragm slightly higher than the left.

During quiet breathing, muscle contraction occurs only during inspiration. Expiration is passive, resulting from the elastic recoil of the lungs and chest.

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