Category Archives: Surface Anatomy

An Unusual Mass

A 76-year-old male who was a current smoker had a chest X-ray performed for symptoms suggestive of a lower respiratory tract infection. He did not have any haemoptysis or weight loss.

Image from New Zealand Medical Journal.   Shoaib Faruqi, et al. (link)

The X-ray was appropriately reported as showing a large soft tissue mass in the right middle zone 10 centimetres in diameter with a smooth superior and lateral outline and ill-defined medial and inferior margins, projecting over the upper pole of the right hilum. A computed tomography scan and chest referral was subsequently suggested.
The radiological finding had a rather benign explanation. On inspection, over the anterior chest wall there was a large sub-cutaneous swelling consistent with that of a lipoma (figure below). This had been present for more than 20 years. It corresponded to the shadow on the chest X-ray. A lateral film confirmed that there was no parenchymal lung lesion and it was the lipoma which was the cause for the radiological shadow.
This case emphasises the importance of interpreting radiological findings in the appropriate clinical context. It also demonstrates the importance of a lateral film in delineating the anatomical position of a chest lesion.
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Abdominal Regions

Topographically, the abdomen may be divided into right and left upper and right and left lower quadrants by vertical and horizontal lines through the umbilicus.mouseover for labels

The abdomen may also be divided into nine regions by two longitudinal lines (right and left midclavicular lines) and two transverse planes (subcostal and intertubercular planes). The regions are: right and left hypochondriac, right and left lumbar, right and left inguinal (or iliac), epigastric, umbilical and hypogastric.

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Both of these schemes are used clinically.

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Pectoralis Major

The pectoralis major is a thick, fan-shaped muscle, situated at the chest (anterior) of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female. Underneath the pectoralis major is the pectoralis minor, a thin, triangular muscle.
mouseover for muscle illustration   photo by Carlos Arias

It arises from the anterior surface of the sternal half of the clavicle; and as low down as the attachment of the cartilage of the sixth or seventh rib.  From this extensive origin the fibers converge toward their insertion; in a flat tendon, about 5 cm in breadth, which is inserted into the lateral lip of the bicipital groove of the humerus. (adapted from wikipedia)

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Trapezius muscle

Trapezius muscle

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