What is the location of the symptom?

Location of Symptoms in Clinical Assessment

Anatomical Location Terminology

When documenting symptom location, use standardized anatomical landmarks to ensure precise communication and appropriate diagnostic workup. 1

Chest and Thoracic Locations

• Sternum (lower, mid, upper): Located in the middle of the anterior chest wall, bounded by the clavicles above and the cartilages of the first seven ribs along the sides 1
• Sternal border (left/right, lower/mid/upper): Along the lateral edge of the sternum, providing a reference point for cardiac and pulmonary examination 1
• Midclavicular line (right/left): An imaginary vertical line originating from the midpoint of the clavicle, commonly used for cardiac apex localization 1
• Intercostal space (right/left, 2nd through 5th): The area between adjacent ribs, defined by superior and inferior rib margins 1
• Anterior axillary line (right/left): An imaginary vertical line descending along the lateral chest wall from the armpit 1

Abdominal Locations

• Epigastrium: The upper and middle region of the abdomen, located within the sternal angle 1

Pelvic Pain Localization

For pelvic symptoms, distinguish between deep/internal pelvic pain versus perineal/superficial pain, as this guides the differential diagnosis and imaging approach. 1

Deep Pelvic Pain

• Associated with pelvic venous disorders, intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis 1
• Initial imaging should be transvaginal ultrasound combined with transabdominal approach 1

Perineal/Vulvar/Vaginal Pain

• Arises from vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain 1
• May require translabial/transperineal ultrasound or side-firing transvaginal probes for optimal visualization 1

Lower Extremity Pain Localization in Children

In children with limb pain, precise localization determines the imaging approach, though referred pain patterns must be considered. 1

• Hip pathology can refer pain to the thigh, knee, or buttock, requiring hip evaluation even when symptoms seem distant 1
• Localized symptoms allow focused radiographic evaluation of the specific area (hip, femur, knee, tibia/fibula, ankle, foot) 1
• Non-localized symptoms may require broader imaging or follow-up clinical reassessment if initial evaluation is negative 1

Neck Mass Location

For neck masses, document the specific anatomical location and relationship to surrounding structures, as this influences the differential diagnosis and risk stratification. 1

• Location helps determine whether the mass is at increased risk for malignancy 1
• Fixed masses or those in certain anatomical locations warrant more aggressive evaluation 1

Central Nervous System Pain Location

For post-stroke pain, the symptom location must correspond to the central nervous system lesion to establish the diagnosis of central post-stroke pain. 2

• Pain should be located in an area corresponding to the stroke territory 2
• The location helps distinguish central post-stroke pain from nociceptive or peripheral neuropathic causes 2

Progressive Multifocal Leukoencephalopathy (PML) Lesion Location

PML lesions have characteristic locations that differ from multiple sclerosis, aiding in differential diagnosis. 1

• PML: Subcortical rather than periventricular, affecting U-fibers and extending into the gyrus, with cortical gray matter involvement in 50% of cases 1
• MS: Focal, generally periventricular lesions, particularly in corpus callosum and spinal cord 1
• Posterior fossa is a less frequent site for PML, and spinal cord presentation is rare 1