Surface anatomy on thorax

In fit, young individuals, both the pericardium and the heart - the heart's sternocostal surface - have very similar topography on the anterior chest wall:

• right border:
  • third right costal cartilage, 1-2 centimetres lateral to the sternum inferiorly to the 5th right chondrosternal junction
  • this border is slightly curved with its concavity medially
  • corresponds to the lateral margin of the right atrium
• inferior border:
  • 5th right chondrosternal junction to the apex beat, typically in the left fifth intercostal space in the midclavicular line
  • corresponds to the inferior margin of the right ventricle
• left border:
  • inferior border of second left costal cartilage 2-3cm lateral to sternal edge inferiorly and obliquely down to apex beat
  • corresponds to the left margin of the left ventricle
• superior border:
  • third right costal cartilage 1-2cm lateral to the sternum to inferior border of second left costal cartilage 2-3cm from the sternum
  • the line slopes superiorly slightly from right to left
  • corresponds to the superior border of the atria

Also, it must be remembered that the fibrous pericardium, and to a lesser extent the serous pericardium, extend along the roots of the great vessels.

The surface markings of the heart are approximated by the cardiovascular silhouette on a standard posteroanterior chest radiogram. It can also be approximated by percussion on the anterior thorax - the area of superficial cardiac dullness.