 Surface anatomy (also called superficial

anatomy and visual anatomy) is the study of

the external features of the body.
 These are the form and proportions of the
human body and the surface landmarks which
correspond to deeper structures hidden from
view, both in static pose and in motion.
 Clavicles. Course transversely along the superior
portion of the chest wall from the manubrium to
the acromion of the scapula and, therefore, are
easily palpable. However, the clavicle, overly rib 1,
which makes rib 1 impalpable.

 Jugular notch of the sternum. Located between the

medial ends of the clavicles.
 Sternal angle (of Louis). Articulation between the
manubrium and sternal body. The sternal angle
serves as the location for the articulation of rib 2
with the sternum at the T4–T5 vertebral level. The
sternal angle is often visible and palpable and
serves as an important surface landmark for
several underlying structures.

 Xiphoid process. An inferior pointed projection of

the sternal body. The xiphoid process lies at the
level of the T9 vertebral body.

 Costal margins. Formed by costal cartilages 7–10

 Thorax is mapped out by arbitary lines which are
as follows:
 Midsternal
The middle line of the sternum
 Mammary, or Midclavicular
Runs vertically downward from a point
midway between the center of the jugular notch
and the tip of acromion.
 Lateral sternal
Along the sternal margin
 Parasternal
Midway between the lateral sternal
and
mammary lines.
 Anterior and Posterior axillary lines
Vertically down from the corresponding
axillary folds.

 Midaxillary line
Runs downward from the apex of the axilla.

 Scapular line
Drawn vertically through the inferior angle of the
scapula.
 The heart is demarcated by:
 A point 9 cm to the left of the midsternal line (apex
of the heart)
 The seventh right sternocostal articulation
 The upper border of the third right costal cartilage
1 cm from the right sternal line
 The lower border of the second left costal cartilage
2.5 cm from the left lateral sternal line.
 Pulmonary valve
Upper level of 3rd left
costal cartilage
 Aortic valve
 At the level of 3rdcostal cartilage,
 medial and below the pulmonary
valve
 Mitral valve (left AV valve)
4th costal cartilage

 Tricuspid valve (right AV valve)

4th costal cartilage on the right s.
 pulmonary valve: junction of superior and middle
thirds of body of sternum and slightly to the left
side; near to left third costal cartilage
 aortic valve: just below and to the right of the
pulmonary valve on left side of middle third of
sternum; level with the third intercostal space
 tricuspid valve: median plane in the inferior third
of the sternal body; opposite the fourth costal
cartilage
 mitral valve: overlapping tricuspid area but more
superior and to the left of sternal body
 Pulmonary valve
A horizontal line (2.5 cm long) behind the
medial end left 3rd costal cartilage and adjoining
part of the sternum.
 Aortic valve
A lightly oblique line (2.5 cm long) behind
the left half of the sternum opposite the 3rd
intercostal space
Mitral valve
An oblique line (3 cm long) behind the left
half of the sternum opposite the left 4th costal
cartilage.
Tricuspid valve
Nearly vertical oblique line (4 cm long)
behind the right half of the sternum opposite the
4th and 5th intercostal spaces
 Second left intercostal space near the
sternum.
 Second right intercostal space near the
sternum
 Left 5th intercostal space 3U inches (9 cm)
from midline, i.e., over apex beat
 Right half of the lower end of the body of the
sternum