Normal reference

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Normal reference

  • Use this chest X-ray as a normal reference for this gallery.
  • A nipple piercing (arrow) is projected over the left anterior 5th rib in the mid-clavicular line.
  • This is near where the apex beat is best palpated and auscultated during clinical examination. This is the 5th intercostal space on the left mid-clavicular line (red ring). You can see from this X-ray that the heart apex (asterisk) is nowhere near this point. However, when clinically examining the heart apex, the patient should be reclining at 45°, and rolled towards their left, with their breath held in expiration. This positions the heart apex exactly at this site.