Triangle of auscultation

The triangle of auscultation is a relative thinning of the musculature of the back, situated along the medial border of the scapula which allows for improved listening to the lungs.

Triangle of auscultation
Triangle of auscultation (shown in pink) of the Visible Human Male
Cross section #1428 of the Visible Human Male showing the structures of the triangle of auscultation
Details
Identifiers
Latintrigonum auscultationis
TA98A01.2.05.006
TA2267
FMA75022
Anatomical terminology

Boundaries

It has the following boundaries:

medially, by the inferior portion of the trapezius
Inferiorly, by the latissimus dorsi
laterally, by the medial border of the scapula

The superficial floor of the triangle is formed by the lateral portion of the erector spinae muscles. Deep to these muscles are the osseous portions of the 6th and 7th ribs and the internal and external intercostal muscles.

Clinical significance

The triangle of auscultation is useful for assessment using a pulmonary auscultation and thoracic procedures.[1] Due to the relative thinning of the musculature of the back in the triangle, the posterior thoracic wall is closer to the skin surface, making respiratory sounds audible more clearly with a stethoscope. On the left side, the cardiac orifice of the stomach lies deep to the triangle. In days before X-rays were discovered, the sound of swallowed liquids were auscultated over this triangle to confirm an oesophageal tumour.

To better expose the floor of the triangle up of the posterior thoracic wall in the 6th and 7th intercostal space, a patient is asked to fold their arms across their chest, laterally rotating the scapulae, while bending forward at the trunk, somewhat resembling the fetal position.

The triangle of auscultation can be used as a surgical approach path.[2][3] It can also be used for applying a nerve block known as the rhomboid intercostal block, which can be used to relieve pain after rib fractures, and a thoracotomy. This nerve block is usually appled by injection into the upper intercostal muscle plane and below the rhombic muscles.[4][5]

References

This article incorporates text in the public domain from page 434 of the 20th edition of Gray's Anatomy (1918)

  1. Malik, Nazish; Tedder, Brandon L.; Zemaitis, Michael R. (2020), "Anatomy, Thorax, Triangle of Auscultation", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30969656, retrieved 2020-11-02
  2. Horowitz, Michael D.; Ancalmo, Nelson; Ochsner, John L. (May 1989). "Thoracotomy through the auscultatory triangle". The Annals of Thoracic Surgery. 47 (5): 782–783. doi:10.1016/0003-4975(89)90148-3. ISSN 0003-4975. PMID 2730202.
  3. Gandy, Kimberly L.; Hoffman, George M.; Vanderwal, Patrick; Tweddell, James S. (2010-01-01), Anderson, Robert H.; Baker, Edward J.; Penny, Daniel J.; Redington, Andrew N. (eds.), "CHAPTER 13 - Surgical Techniques", Paediatric Cardiology (Third Edition), Philadelphia: Churchill Livingstone, pp. 219–237, doi:10.1016/b978-0-7020-3064-2.00013-8, ISBN 978-0-7020-3064-2, retrieved 2020-11-02
  4. Yayik, Ahmet Murat; Aydin, Muhammed Enes; Tekin, Erdal; Ulas, Ali Bilal; Ahiskalioglu, Ali (December 2012). "An alternative plane block for multiple rib fractures: Rhomboid Intercostal and Sub-Serratus block (RISS)". The American Journal of Emergency Medicine. 37 (12): 2263.e5–2263.e7. doi:10.1016/j.ajem.2019.158429. ISSN 0735-6757. PMID 31526541. S2CID 202673902.
  5. Ökmen, K (1 April 2019). "Efficacy of rhomboid intercostal block for analgesia after thoracotomy". The Korean Journal of Pain. 32 (2): 129–132. doi:10.3344/kjp.2019.32.2.129. PMC 6549589. PMID 31091512.
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