Chest Shape

Before ascultating the chest, notice the shape and symmetry of the chest wall. In this infant, the antero-posterior (AP) diameter appears greater than normal, and there was concern that the AP diameter of the left chest was greater than that on the right. (Notice the white lead on the right nipple and the gold lead over the midline) This finding is suspicious for pnuemothorax, which can occur spontaneously in well newborns. Congential diaphragmatic hernia may present with an abdomen that appears flat relative to the chest (scaphoid abdomen), but in that case severe respiratory distress would be expected.

photo by Janelle Aby, MD