Left atrial enlargement is a surrogate marker for disease progression in congenital post-tricuspid left-to-right shunt lesions. Despite advanced imaging, a need persists for a more accessible modality like electrocardiography for early detection of left atrial enlargement. This study evaluates the diagnostic accuracy of established electrocardiography standards and a novel electrocardiography criterion (with altered position of chest leads) in identifying left atrial enlargement in children with post-tricuspid shunt lesions, enabling routine monitoring and timely referrals. This cross-sectional observational study enrolled 227 children (1 month-18 years) with post-tricuspid shunts (ventricular septal defect, patent ductus arteriosus, and aortopulmonary window). Left atrial volume determined by 2D echocardiography was used as the reference standard to compare the diagnostic accuracy of electrocardiography parameters (negative P-terminal force at V1, P/PR segment, and bifid P wave) in detecting left atrial enlargement. The diagnostic accuracy of a novel method of measuring negative P-terminal force with lead V1 placed at the 2nd right intercostal space was compared with traditional electrocardiography parameters. Electrocardiography parameters showed diagnostic accuracy of 52.9-61.5%, sensitivity of 32.5-90.8%, and specificity of 17.8-89.7% for left atrial enlargement. Novel P-terminal force in V1 at the 2ndintercostal space (>151.2 mm.ms) had 32.5% sensitivity, 89.7% specificity, and 59.5% accuracy. At the 4th Rt. Intercostal space (novel P-terminal force in V1 ≥40 mm.ms), it had 74.2% sensitivity, 42.1% specificity, and 59.0% accuracy. Measurement of the terminal negative force of the P wave at 2nd intercostal spacehas improved the specificity in the detection of left atrial enlargement. Future studies with higher sample sizes in a heterogeneous population might characterise this as a potential tool in detecting left atrial enlargement.

BackgroundThis cross-sectional study with limited prospective cohort follow-up aimed to determine the prevalence of Brugada-type ECG patterns (BTEPs) among asymptomatic Upper Egyptians using standard and high precordial leads, and to assess the short-term arrhythmic outcomes of positive cases.MethodsA total of 318 participants without arrhythmic symptoms were enrolled between June 2022 and June 2023. Standard 12-lead and high precordial ECGs (V1–V2 at 2nd intercostal space) were recorded. BTEPs were identified based on β-angle ≥ 58°, base length ≥ 1.5 mm at isoelectric line, and base width ≥ 4 mm at 0.5 mV. Positive cases underwent clinical follow up, echocardiography and Holter monitoring every 6 months for 12 months. Data was analyzed using McNemar’s test for paired proportions and logistic regression for confounder adjustment.ResultsTwo cases (0.63%; 95%CI: 0.17–2.26%) exhibited BTEPs on standard ECGs versus eight (2.52%; 95% CI:1.28–4.88%) on high precordial ECGs (p = 0.041). All positive cases were males. During follow-up, arrhythmias were documented in 7/8 cases (87.5%), including supraventricular tachycardia (n = 4), non-sustained VT (n = 1), and Mobitz I AV block (n = 1). No patient had family history of sudden cardiac death. The observed prevalence and arrhythmic rates were consistent with prior international data.ConclusionRoutine use of High precordial leads ECG in upper Egyptians showed comparable benefit of detecting Brugada patterns as reported globally. In addition to type I, the follow up of originally asymptomatic type II and III Brugada patterns may show variable arrhythmic presentations. However, due to small sample size and short-term follow-up, results should be considered preliminary pending larger confirmatory studies.Trial Registration Our study has been registered as a clinical trial, clinicalTrial.gov ID: NCT05116488 at 10th November 2021.

Tracheal intubation (TI) is critical in neonatal intensive care and delivery rooms, requiring precise placement of the endotracheal tube (ETT) to prevent complications. Various methods confirm ETT position; whilst chest radiography remains standard for identifying ETT depth, ultrasonography (USG) shows promise as a real-time, radiation-free alternative. That is why we aimed to evaluate the concordance between tracheal ultrasound (TUS) and chest x-ray to identify the depth of the ETT in the trachea in preterm neonates and to compare the reproducibility of TUS done by a trainee neonatologist and an expert radiologist. This cross-sectional study involved 85 preterm infants who had an ETT. Tracheal ultrasonography was performed by a neonatologist (who had been trained in chest ultrasonography for 3 months) and repeated by an expert radiologist. Operators were blinded to the radiographic results. The overall agreement was good, with near-complete concordance for ETT localization at the 2nd intercostal space across techniques: 89.4% (PSA 93.5%) between expert TUS and CXR, 82.4% (PSA 89.1%) between trainee TUS and CXR, and 89.1% (PSA 92.3%) between expert and trainee TUS.Conclusion: Bedside tracheal ultrasonography is a reliable, fast, safe, and effective method for assessing endotracheal tube position in the NICU. With adequate training, neonatologists can perform the procedure independently which speeds up ETT position confirmation.Trial registration: The clinical trial was retrospectively registered on clinical trials.gov 7/17/2025. CLINICALTRIALS.GOV ID: NCT07073105. https://CLINICALTRIALS.GOV/STUDY/NCT07073105.What is Known:• Improper endotracheal tube (ETT) placement and depth in the trachea can cause severe complications.• Chest X-ray is used for the identification of ETT depth in the trachea but causes delays and radiation exposure.What is New:• Tracheal ultrasound offers rapid, radiation-free confirmation.• With brief training, a neonatology trainee achieved agreement with an expert radiologist in identifying the depth of ETT in the trachea in preterm infants.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-025-06626-3.

ABSTRACTThoracocentesis for pneumothorax, even under fluoroscopy, could bring about penetrating cardiac injury. Not the 5th but the 2nd intercostal space should be selected for the needle point because the former is too close to the apex of the heart.

Mediastinal teratomas are germ cell tumors that account for 15% of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell approach. We present a case of a large mature teratoma occupying the left thoracic cavity that was treated by a thoracoscopic surgery with a lateral mini-thoracotomy. Preoperatively, we marked the lateral thoracic area near the largest cyst. In the right lateral recumbent position, a 4-cm incision was made in the left 6th intercostal space. Several large cysts were drained as much as possible. In the supine position, three 5-mm ports were placed in the 2nd, 5th, and 6th intercostal spaces. The left lobe of the thymus and the tumor were resected en block. Pathologically, the tumor was a mature teratoma. The patient had a good postoperative course and was discharged on the 8th postoperative day.

Abstract Introduction: Pancreatico-pleural fistula (PPF) with pleural effusion is a rare complication of chronic pancreatitis, occurring in 0.4-0.45% of cases. Most are left-sided with amber-colored effusion. Here, we present an unusual right-sided PPF with black pleural exudate, successfully treated using a multimodal approach. Case description: A 51-year-old male with a history of chronic alcoholism presented with one month of sharp right-sided chest pain, worsened by deep breathing, and progressive breathlessness. Examination showed tachypnea, bilateral clubbing, a left-shifted trachea, dullness to percussion in the right 2nd intercostal space, and decreased breath sounds on the right. Imaging revealed a massive right pleural effusion with lower lobe collapse, and thoracentesis drained 2.6L of black exudate, providing temporary relief. Lab tests showed elevated serum amylase (331 U/L) and lipase (1276 U/L), with pleural fluid amylase and lipase >10,000 U/L, LDH at 380 U/L, and no atypical or malignant cells. Abdominal CT indicated chronic necrotizing pancreatitis with a walled-off pseudocyst and MRCP showed pancreatic duct disruption at the distal body and an adjacent 4.5x2.2 cm fluid collection with a fistulous tract extending through the esophageal hiatus and connecting to the right pleural space. Diagnosed with a right-sided pancreatico-pleural fistula and black pleural effusion, he was initially managed conservatively with NPO, IV fluids, intercostal drain (ICD), antibiotics, and octreotide for 3 weeks. Endoscopic intervention due to inadequate treatment response involved ERCP with pancreatic duct stenting and pseudocyst drainage. Postoperatively, the pleural drain output gradually decreased, and the ICD was removed on day 5, with follow-up imaging showing no pleural effusion and the patient remaining symptom-free. Discussion: Pancreatico-pleural fistula is a rare cause of pleural effusion accounting for less than 1% cases and is often associated with delayed or missed diagnosis. Described mechanism for pleural effusion secondary to chronic pancreatitis include disrupted pancreatic duct often with a walled-off pseudocyst, forming an abnormal posterior connection into the pleural cavity. PPF are typically left-sided but can rarely present on the right with black pleural effusion. High pleural fluid amylase suggests it, but imaging or endoscopy is required to confirm. PPF is usually managed conservatively with pleural drain and octreotide but recurrent and non-resolving pleural effusions require endoscopic or surgical correction. Our case emphasizes the need to consider PPF in chronic alcoholics with recurrent black pleural effusions. While rare and typically left-sided, PPF can occur on the right. Prompt intervention is crucial for effective management.

Needle decompression (NDC) is the primary treatment of tension pneumothorax (tPTX) in prehospital settings. This study compared 10-gauge (10ga) and 14-gauge (14ga) fenestrated needle/catheter units for NDC. We hypoth-esized 10ga needle/catheter units would demonstrate higher tPTX decompression rates compared to 14ga needle/catheter units. A non-randomized, non-blinded study was conducted using human cadavers with artificially induced tPTX (pleural pressure of 15mmHg). A 10ga or 14ga unit was in-serted into the 5th intercostal space, anterior axillary line, or the 2nd intercostal space, midclavicular line. Successful NDC was defined as a pressure decrease to less than 4mmHg. In 116 NDC attempts, there was no difference in the success rate of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, P=1.0). The median time to decompression of tPTX was faster using 10ga at 22.0s (IQR 14.5-42.0) vs. 14ga at 39.8 seconds (IQR 30.3-57.6, P<.001). No difference was found in time to successful decompression between AAL and MCL sites (36.0s [IQR 21.7-51.7] vs. 30.4s [IQR 18.7-49.5], P=.46). The 10ga needle/catheter units achieved an audible release of air with the needle still in place during successful NDC more frequently compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con-clusion: NDC with 10ga fenestrated needle/catheter units was similarly effective, but significantly faster than 14ga units for tPTX in a cadaveric model. A safe, depth-limiting technique was over 90% effective across all NDC sites.

A mathematical model for derivation of Elevated-Electrode-Placement Electrocardiogram (EEP-ECG) leads from a standard 12-lead electrocardiogram.

Objectives:The neural respiratory drive (NRD) is a critical determinant of breathlessness, influenced by the balance between ventilatory load and respiratory muscle capacity. This study aimed to evaluate the impact of body positions on NRD in young healthy adults (18-50 years) and to identify the optimal position for assessing NRD among the healthy subjects.Methods:Surface electromyography (sEMG) data from the 2nd intercostal space parasternal muscle was collected in supine, sitting, and standing positions among young healthy adults. NRD parameters, including EMG Para max% and Neural Respiratory Drive Index (NRDI), were analysed and compared among positions using ANOVA.Results:Significant differences in NRD values were observed across body positions, with standing vs. supine vs. sitting yielding higher values in both sexes respectively (Males: 5.113±0.437, 4.404±0.576, 4.913±0.623; P<0.001 and Females: 7.444±0.416, 6.435±0.266, 6.748±0.390; P<0.001). Post hoc analysis reveals significant difference in standing vs supine vs sitting position. These findings highlight the influence of body position on NRD measurements.Conclusions:The study emphasizes the importance of considering body position when evaluating NRD in healthy individuals. These factors should also be taken into account in clinical assessments to ensure accurate interpretation of NRD and related respiratory functions.

Advanced emphysema leads to high false positivity rate for pneumothorax in point of care ultrasound

Abstract Introduction Traditional guidelines for the primary treatment of pneumothorax differ and include simple aspiration, small-bore catheter or chest tube drainage. Treatment via conventional chest tube drainage connected to a suction system is usually associated with hospitalization for approximately 6 days, immobilization, and discomfort. However, reliable patients who do not want to be hospitalized can safely be treated as outpatients with a small-bore catheter attached to a Heimlich valve, True-Close Thoracic Vent (TV). We started using TV at Capio S:t Görans hospital (CStG) in 1999 in cooperation with dr Leif Dernevik, Department of Thoracic Surgery, Sahlgrenska University Hospital. Method TV is a minimally invasive, immediate salvage device for the treatment of pneumothorax. Indications are primary &amp; secondary spontaneous and iatrogenic pneumothorax. The exclusion criteria: hydro/hemopneumothorax, patient refusal, dementia or psychologically unstable, and underlying pulmonary disease requiring supplemental oxygen. Patients are identified and operated on in the ward or postop area. Operation technique: 2nd intercostal-space (IC2) in the midclavicular line (MCL), local anesthetics together with light iv sedation, mini thoracotomy (no-bore safe ATLS-technique), aspiration of air and fixation of TV. Post drain x-ray is conducted and most of the patients are sent home the next day with a 5+2-day ambulatory treatment plan. Result 2016-2023: Cases n 445 Male/female 75/25% Success rate 93% AVLOS 2,3 days Mortality 0% Morbidity grade 3b, one patient (erroneous placement in IC1 MCL). Discussion TV is a safe, cost-effective ambulatory method for treatment of pneumothorax. By using this technique, CStG has saved approximately 2800 beds since 1999 compared to non-ambulatory pneumothorax care.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow obstruction. Patients with COPD often experience reductions in lung volumes and vital capacity due to chronic respiratory muscle weakness. Additionally, they may exhibit decreased lung distensibility, leading to restrictions in lung volume. The passive recoil of the thoracic cage is influenced by gross muscle weakness, altering the neutral position at which lung and cage recoil pressures are balanced. Mobilizing rib cage joints is a specific therapeutic goal, as it aims to improve reduced rib cage mobility commonly observed in obstructive lung disease. Method: A study was conducted on COPD patients aged over 40 years, specifically including males with VC&lt;80%. Participants with unstable vital parameters, active lung infections, or those requiring continuous oxygen therapy or mechanical ventilation were excluded. The participants were divided into two groups: Group 1 received chest mobilization and breathing exercises, while Group 2 received only breathing exercises. Chest expansion measurements were taken at the 2nd intercostal space, 4th intercostal space, and xiphoid process in both groups before and after the procedures. Result: Result obtained from SPSS20. Mean-age of Group1 was (61.9+6.0) &amp; of Group2 was (62.05+6.1). Comparison between groups found using independent t-tests. There was significant difference of chest-expansion at 2nd IC, 4th IC and xiphoid process between both the groups. Chest-expansion at 2nd IC(M=2.0), 4th IC(M=2.85) and xiphoid process (M=3.43) was increased in group1 than group2 (M=1.58), (M=2.01) &amp; (M=2.49) having significant difference of p&lt;0.05. Conclusion: This study concludes that Chest Wall mobilization has significant effect on Chest-expansion in COPD patients. Hence Chest-Mobilization is definite tool for the improving condition of COPD patients, so it should be included as a part of management in COPD patients with other exercise treatment-programs. Keywords: Chest mobilization, COPD, Chest expansion, Cloth tape measurement

Diagnostic yield of a smartphone-operated, 6-lead device in Brugada syndrome

Abstract Introduction The dysfunction of vascular access (VA) constitutes one of the main problems faced by nephrologists and patients in chronic hemodialysis (HD). This challenge becomes particularly worrying in patients who have depleted their upper extremity venous resources and have no longer arteriovenous fistula available, requiring the placement of a central venous catheters. It leads to an increase in morbidity and mortality and a higher of infections, thrombosis and exhaustion of access points. In such cases, alternatives to conventional VA are limited, with intracardiac access being an emerging option, albeit with very limited documented experience. Case Report We describe the case of a 68-year-old male with a history of hypertension, nasopharyngeal carcinoma in 2012 treated with chemotherapy and radiotherapy. In 2018 he was diagnosed with low-grade urothelial bladder carcinoma (PT1G1) that infiltrated the subepithelial corion while sparing the muscular layer. He also had severe hydronephrosis with impaired renal function, requiring radical cystoprostatectomy with Bricker bladder reconstruction and subsequent bilateral nephrostomy due to persistent dilatation and progressive deterioration of renal function. He began chronic HD in June 2020 through a left femoral catheter due to the inability to access the upper thoracic vascular tree due to stenosing fibrosis from previous radiotherapy. He was placed on the waiting list for a kidney transplant (KT) in the right iliac fossa but experienced multiple catheter dysfunction episodes, requiring the placement of a right femoral venous catheter to continue with his HD sessions. Additionally, peritoneal dialysis was not considered due to previous urological surgery. Considering the limitation of VA and the possibility of KT as its best alternative, we opted for the insertion of a tunnelled intracardiac catheter at the right atrium. This procedure was conducted by the Cardiac Surgery Department on 03/12/2021 through a median sternotomy in the 4th intercostal space. A permanent hemodialysis catheter was inserted in the right atrium through the 3rd intercostal space and fixed with a purse-string suture. It was then tunnelled under the breast to the 2nd intercostal space through a counter-incision. The cuff was appropriately placed in the subcutaneous tissue (Figs 1 and 2). The intervention proceeded without any complication and the catheter exhibited normal functionality. After that, the patient received anticoagulation with enoxaparin the days between dialysis sessions. Consequently, the right femoral catheter was safely removed. Two weeks later, the patient successfully received a KT from a deceased donor. He was discharged on the day 11st post-KT with any complication and maintains a good renal function after 2 years of follow-up with a serum creatinine 1.7 mg/dL (eGFR: 39 ml/min). The intracardiac catheter was removed one month later through a mini-thoracotomy. Conclusions Intracardiac VA is an unusual and high-risk resource that seems an alternative in patients with exhausted VA with no alternative emergency renal replacement therapy, so it should be considered as the last resort. In the case of our patient, the implantation of this catheter allowed for the continuation of dialysis and access to KT.

Objective: evaluate echocardiographic and computed tomography characteristics related to minimally invasive aortic valve replacement technique through the right anterior thoracotomy at the 2nd intercostal space. Methods: study on 74 patients undergoing aortic valve replacement surgery through the right anterior thoracotomy at the 2nd intercostal space at Hanoi Heart Hospital and 108 Military Central Hospital, from October 2019 to December 2022. Patients underwent preoperative echocardiography and multiple slices computed tomography to assess the lessons of aortic valve, valve annulus diameter, and intercostal space width. Results: The ratio of aortic valve stenosis is 55.4%, stenosis combined with regurgitation is 31.1%, and aortic regurgitation is 13.5%. The average valve annulus diameter on computed tomography scans is 26.5 ± 3.1 mm (smallest 20; largest 36); average 2nd intercostal space width 18.1 ± 3.1 mm (smallest 11; largest 25). Valve annulus diameter measured by computed tomography correlates closely with actual prosthetic valve size (r = 0.54, p &lt; 0.001); measured by echocardiography had a weak correlation and not statistically significant. The prosthetic valve size to be replaced is smaller than the valve annulus diameter measured on computed tomography, with an average of 4.8 ± 2.7 mm in aortic valve stenosis, 5.7 ± 2.0 mm in combined stenosis and regurgitation, and 7.2 ± 2.9 mm in aortic regurgitation, in which the difference between valve stenosis and regurgitation is statistically significant (p = 0.01). Conclusions: Minimally invasive aortic valve replacement technique through the 2nd intercostal space right thoracotomy, with cutting the 3rd rib, is suitable for Vietnamese anatomy. Valve annulus diameter measured by computed tomography has a good linear correlation and can be a predictor for prosthetic valve size before surgery.

Objectives: Pain following sternotomy has always been an issue of major concern for anesthesiologists. The incidence of pain is as high as 49% at rest following coronary artery bypass grafting. We planned to utilize the sub-pecto-interfascial plane (SIP) block and erector spinae plane (ESP) block to determine its efficacy and quality of analgesia as compared to conventional intravenous analgesia. Material and Methods: After the Institutional Ethics Committee’s approval, we recruited 105 patients and randomized them into three groups. Group 1 received conventional analgesia, group 2 SIP, and group 3 ESP block. Group 2 and Group 3 received allocated blocks after induction of balanced general anesthesia under ultrasound guidance. With high-frequency linear probe (13 MHz) planes identified, a mixture of injection ropivacaine (0.375%) and dexmedetomidine (1.1 mcg/mL) was deposited. In group 2, six injections of 6 mL each at the 2nd, 4th, and 6th intercostal spaces in the bilateral parasternal region. In group 3, two injections of 20 mL of the above-mentioned mixture on each side above the transverse process of the T5 vertebra under the erector spinae muscle plane were injected. All patients were monitored throughout the procedures, and their vitals were recorded. Heart rate, systolic blood pressure, and diastolic blood pressure were noted at baseline, at skin incision, at sternotomy, and 30 min post-extubation. Patients were followed for total fentanyl consumption, pain score (numerical rating scale [NRS] score), and peak inspiratory flow rate, which were noted at extubation and 2, 4, 6, 8, 12, and 24 hours post-extubation. Levels of C-reactive protein (CRP), cortisol, and prolactin were done at baseline and 24 h after surgery. Extubation time, time of first oral intake, and total length of intensive care unit (ICU) stay were also compared between the groups. Results: Total fentanyl consumption was significantly lower (P &lt; 0.005) in group 2 and group 3 compared to group 1. Patient receiving blocks were significantly lower NRS score compared to the control group. Spirometry has shown improved results in block groups catering to early discharge from ICU. Rise in levels of CRP, cortisol, and prolactin were much higher in group 1 as compared to group 2 and group 3. Conclusion: The application of ESP and SIP blocks is far superior than conventional parenteral analgesics in terms of pain score, total opioid’s consumption, hemodynamic maintenance, spirometry efforts, and length of ICU stays.

Echocardiography is an effective tool for diagnosing cardiovascular disease. However, numerous challenges affect its accessibility, including skill requirements, workforce shortage, and sonographer strain. We introduce a navigation framework for the automated acquisition of echocardiography images, consisting of 3 modules: perception, intelligence, and control. The perception module contains an ultrasound probe, a probe actuator, and a locator camera. Information from this module is sent to the intelligence module, which grades the quality of an ultrasound image for different echocardiography views. The window search algorithm in the control module governs the decision-making process in probe movement, finding the best location based on known probe traversal positions and image quality. We conducted a series of simulations using the HeartWorks simulator to assess the proposed framework. This study achieved an accuracy of 99% for the image quality model, 96% for the probe locator model, and 99% for the view classification model, trained on an 80/20 training and testing split. We found that the best search area corresponds with general guidelines: at the anatomical left of the sternum between the 2nd and 5th intercostal space. Additionally, the likelihood of successful acquisition is also driven by how long it stores past coordinates and how much it corrects itself. Results suggest that achieving an automated echocardiography system is feasible using the proposed framework. The long-term vision is of a widely accessible and accurate heart imaging capability within hospitals and community-based settings that enables timely diagnosis of early-stage heart disease.

Pneumothorax occurs when the pleural space is filled with air due to trauma, iatrogenic injury, or underlying lung disease. If this air leak forms a one-way valve that causes air to be trapped, an uncontrolled increase in air volume can occur, causing lung collapse and shift of the mediastinum to the contralateral side, which can eventually cause respiratory and hemodynamic disturbances or even death. Here, we report a 46-year-old male patient who came to the hospital complaining of shortness of breath and chest pain radiating to the left shoulder. On physical examination, the patient had severe shortness of breath, tracheal deviation, decreased expansion and air entry of the left hemithorax, hyperresonance of the left hemithorax, and a shift of the punctum maximum of the heart sounds to the left sternal line. The chest x-ray performed on the patient confirmed the suspicion of a tension pneumothorax. A needle decompression in the 2nd intercostal space in the left midclavicular line failed to improve the tension pneumothorax. A chest tube insertion was performed which managed to improve the patient's clinical condition.

Literally, ‘evergreen’ means ... evergreen. An ‘evergreen’ lasts over time, and never loses its usefulness. It is ‘timeless’; hence, it is not affected by changes in society, nor is it influenced by the fashion of the moment. On the other hand, sometimes in life a passion or a habit might fade or end for no specific reason ... so, little by little, things change, and an endless passion may become a love gone wrong ... What happens though, when one realizes that what was left behind was the one, true, absolute reality one desired? The past from which we had separated could very well return strong, determined to be lived with greater intensity than before: a ‘rekindled flame’. This experience can apply to several areas and also to the field of surgery. This analogy may undoubtedly be applied to the ‘island technique’ (IT) used for the reimplantation of supra-aortic trunks (SAT) in aortic arch and Frozen Elephant Trunk (FET) surgery, a technique that over recent years has been mostly abandoned in favour of single reimplantation, but that Dohle et al., with their experience, have ‘rekindled’

Background: Chest expansion measurement is included as a standard mode of measurement to evaluate patient’s baseline status of respiratory function. There are various anatomical and physiological differences between adult and paediatric respiratory system hence, adult values of chest expansion cannot be used as reference values in paediatric population. Also, there is lack of recent data that has evaluated chest expansion values in paediatric age group. So, the present study was undertaken to find out normal chest expansion values in children between 5-12 years of age. It is important to know the reference value for precise interpretation. Methodology: A cross sectional observational study was carried out in 600 children between age group of 5-12 years and with normal BMI(without H/O any cardiac/respiratory illness, musculoskeletal or neurological diseases, spinal deviations, cough and cold). Chest expansion measurements were assessed in sitting position at three levels that is, 2nd, 4th and 6th intercostal spaces(ICS), using an non- elastic measuring tape. It was taken as thoracic circumference at the end of maximum exhalation and inspiration. An average of three such readings at each level was taken into consideration. Results: To find value of chest expansion at 2nd, 4th and 6th ICS levels a average values of the three measurements taken at each level at same time was taken into consideration. Conclusion: The normative values of chest expansion in healthy children between age group of 5-12 years is 2nd Intercostal space- 1 inch/ 2.5 cm, 4th Intercostal space- 1 inch/2.5 cm, 6th Intercostal space- 1.7 inch/ 4.25cm. KEY WORDS: Chest Expansion, Normative Values, Children, Paediatric.