Mediastinal Position Mediastinal Position Position of mediastinum gives important clues to the nature of process in each hemithorax. Trachea is the index of upper mediastinum and heart of the lower mediastinum. Method of Exam Examine the position of mediastinum by standing in front of the patient. Make certain that the patient is seated straight or preferably standing erect. Trachea is the index of upper mediastinum.
Heart is the index of lower mediastinum.
Position of the heart can be used as an index of mediastinum only when it is not enlarged. Inspect for the symmetry of clavicular insertion of both sternomastoids . Assess and compare the space between the trachea and sternomastoid on either side. Keep the tips of your index and ring fingers over the medial end of the clavicles. Then, with the middle finger, assess the space between the trachea and sternomastoid.