Topic Overview

Pectoral Region – Surface Landmarks

Bony Landmarks

• Clavicle → easily palpable throughout its length.

• Sternoclavicular joint → at the medial end of clavicle.

• Acromioclavicular joint → at the lateral end of clavicle.

• Coracoid process of scapula → palpable just below lateral third of clavicle.

• Jugular (suprasternal) notch → depression between medial ends of clavicles at level of T2 vertebra.

• Sternal angle (Angle of Louis) → junction of manubrium and body of sternum, corresponds to:

  • Level of 2nd costal cartilage.

  • Intervertebral disc between T4–T5 vertebrae.

  • Important clinical landmark for counting ribs.

Soft Tissue Landmarks

• Anterior axillary fold → formed by lower border of pectoralis major.

• Posterior axillary fold → formed by latissimus dorsi and teres major.

• Inframammary fold → junction between lower border of breast and chest wall.

Breast Surface Markings (overview, detailed later)

• Extends from 2nd to 6th rib vertically, and from sternum to mid-axillary line horizontally.

• Nipple → usually at 4th intercostal space in males and nulliparous females (variable in females after puberty/pregnancy).

Vascular & Nerve Landmarks (palpable/palpation points)

• Cephalic vein → runs in the deltopectoral groove (between deltoid and pectoralis major).

• Thoracoacromial artery → pierces clavipectoral fascia near coracoid process.

• Lymph nodes → palpable in anterior axillary fold (pectoral group of axillary nodes).

Clinical Relevance

• Jugular notch → useful for tracheal intubation and central line placement.

• Sternal angle → landmark for 2nd rib; aids in counting ribs and intercostal spaces.

• Anterior axillary fold → palpable guide in axillary dissection and surgery.

• Coracoid process → used as surface landmark for brachial plexus block.