Assessment of chest expansion with deep inspiration helps identify the side of
Method of Exam
- Overall Chest Expansion:
Take a tape and encircle chest around the level of nipple. Take measurements at the end of
deep inspiration and expiration.
Normally, a 2-5" of chest
expansion can be observed. Any lung or pleural disease can give rise to a decrease in
overall chest expansion. It is typically low in patients with COPD. These patients have a
very high FRC and have limited capability to expand the chest from this position.
- Symmetry of Chest Expansion:
Have patient seated erect or stand with arms on the side. Stand behind patient. Grab the
lower hemithorax on either side of axilla and gently bring your thumbs to the midline.
Have patient slowly take a deep breath and expire. Watch the symmetry of movement of the
hemithorax. Simultaneously, feel the chest expansion. Place your hands over upper chest and apex and repeat the process. Next,
stand in front and lay your hands over both apices of
the lung and anterior chest and assess chest
Chest expansion is symmetrical. Both sides take off at the same time and to the same
Asymmetrical chest expansion is abnormal. The abnormal side expands less and lags behind
the normal side. Any form of unilateral lung or pleural disease can cause asymmetry of
- Apply different amounts of pressure and note the effect
- Have patient sit crouched up and note its effect on the symmetry of chest
expansion. Chest expansion is asymmetrical in both of these instances. That is why it is
important to have patient erect and use equal amount of pressure with hands in assessing
Let us say that the patient has decreased chest expansion on right side. Now that we know
the abnormal side is right, with the mediastinum shifted to left, then it would mean a
pushing lesion from right. The pushing lesions are pneumothorax, pleural effusion and
large mass. The next step will help us narrow down those possibilities.