by joining points A to B as shown in the diagram. • Point A lies at the lower

Surface marking of Heart :

1. Superior border – Superior border is formed by joining points A to B as shown in the diagram.
• Point A lies at the lower border of the left coastal cartilage about 1.3 cm from the sternal margin.
• Point B lies at the upper border of 3rd right coastal cartilage about 0.8 cm from the sternal margin.

2. Inferior border – Inferior border is formed by joining points D and E.
• Point D lies at 6th right coastal cartilage about 2 cm away from the sternal margin.
• Point E lies above 6th coastal cartilage about 9 cm away from the mid sternal line.

3. Right Border – Right border is formed by joining B, C and D points. The maximum convexity is about 3.8 cm from the median plane in 4th intercoastal space.

4. Left border – Left border is formed by joining points A and E.

5. Apex – Apex is formed by left ventricle and is found in 5th left intercoastal space. Point E which is 9 cm away from mid sternal line is basically the apex of heart.

6. Atrioventricular groove – It is marked by a line drawn from sternal end of left 3rd coastal cartilage to the sternal end of right coastal cartilage.

7. Pericardium – Pericardium is the area of chest wall overlying the heart.

Surface marking of Liver :

1. Upper border – Upper border is formed by joining points 1, 2 and 3.
• Point 1 lies in the left 5th intercoastal space below and medial to left nipple.
• Point 2 lies at the xiphisternal joint.
• Point 3 lies at the upper border of right 5th coastal cartilage.

2. Lower border – Lower border is formed by joining points 1, 4, 5, 6 and 7.
• Point 1 lies in the left 5th intercoastal space below and medial to the left nipple.
• Point 4 lies at the tip of 8th coastal cartilage.
• Point 5 lies at the transpyloric plane in the midline.
• Point 6 lies at the tip of right 9th coastal cartilage.
• Point 7 lies at the tip of right 10th coastal cartilage.

3. Right border – Right border is formed by joining points 3 and 7.

Surface Marking of Lungs :

1. Apex – It coincides with cervical pleura and is represented by a convex line upwards rising 2.5 cm above the medial one third of clavicle point (A point on right side and 1 point on left side).

2. Anterior border of Right Lung – Anterior border of right lung coincides very closely with the anterior margin of pleura and is obtained by joining points B, C and E.
• Point B lies at sternoclavicular joint.
• Point C lies in median plane at sternal angle.
• Point E lies in the median plane just above the xiphisternal joint.

3. Anterior border of Left Lung – Anterior border of left lung corresponds to the anterior margin of pleura up to the level of fourth coastal cartilage at points 2, 3 and 4.

4. Cardiac Notch – Cardiac notch lies below the level of 4th coastal cartilage. From the level of 4th coastal cartilage, it passes laterally for 3.5 cm from the sternal margin and then curves downwards and medially to reach 6th coastal cartilage 4 cm from the median plane (points 5 and 6).

5. Inferior Border – Inferior border is same for both the lungs. It lies 2 ribs higher than pleural reflection.

6. Posterior Border – Posterior border coincides with posterior margin of pleural reflection except that it’s lower end lies at the level of tenth thoracic spine.

7. Horizontal Fissure – Horizontal fissure is present only on right side by a line joining
• A point on the anterior border of right lung at the level of 4th coastal cartilage.
• A second point on the fifth rib in the mid axillary line.

Surface marking of the Ureter :

Surface marking for ureter is done both on the front as well as back.

1. Surface marking from front :
It is done by a line joining tip of the 9th coastal cartilage and the pubic tubercle.

2. Surface marking from the back :
It is done by a line joining second lumbar spine to the posterior superior iliac spine.

Contributor- Medico Eshika Keshari