Chest Expansion

Assessment of chest expansion with deep inspiration helps identify the side of abnormality.

Method of Exam

  1. 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.

  2. 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 expansion.


Chest expansion is symmetrical. Both sides take off at the same time and to the same extent.

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 chest expansion.


  1. Apply different amounts of pressure and note the effect
  2. 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 chest expansion.


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.