Expansion
Pushed away by pneumothorax and effusion; pulled towards by collapse and fibrosis
Expansion
Away from the lesion (pushed)
- Tension pneumothorax
- Large pleural effusion
- Massive mediastinal mass
- Retrosternal goitre
Towards the lesion (pulled)
- Upper lobe collapse
- Pneumonectomy
- Upper zone fibrosis, such as old tuberculosis
The trachea reflects the upper mediastinum, so it is most sensitive to upper zone pathology. The apex beat reflects the lower mediastinum. Checking both localises the process vertically as well as horizontally.
A slight deviation of the trachea to the right at the thoracic inlet is a normal finding in many people, caused by the aortic arch on the left.