PERCUSSION OF LUNG
FIELDS
- Dr. Aditya Sanjeevi
SURFACE MARKINGS OF LUNG
Contd.
POSITION OF THE PATIENT
• Sitting position is ideal.
• In supine position there can be alteration of percussion note by the underlying
structure on which the patient lies.
ANTERIOR PERCUSSION: The patient sits erect with the hands by his side.
POSTERIOR PERCUSSION: The patient bends his head forward with the hands
over the opposite shoulders – keeps the scapulae further way : more lung
available for percussion
LATERAL PERCUSSION: Patient sits with his hands held over the head.
PRINCIPLES OF PERCUSSION
• Percussion sets the body surface (chest wall) and underlying tissues into motion.
• The motion of the surface and underlying tissues produce audible sounds and
palpable vibration
• Helps to determine whether the underlying tissues are:
Air-filled
Fluid-filled
Solid
• organs give rise to sounds of different:
- loudness(intensity)
- pitch (high or low)
- duration
AIMS OF PERCUSSION
• These differences in sound quality allow
- to establish organ size (boundaries ) = topographic percussion
- to recognize abnormal formations (fluid, growth etc,) = comparative percussion
- to check movements of organs and abnormal formations
• The sound quality of percussion depends on
- the mode of percussion
- air contents of the organ
- the elasticity of the superficial structures
CONTD.
• SKODIAC / SUBTYMPANITIC / BOXY QUALITY
Above the level of pleural effusion
• CRACKPOT RESONANCE
Elicited by clasping moist hands together and striking it against the
knee
Seen in: Large cavity communicating with a bronchus
TECHNIQUE OF PERCUSSION
• Hyperextend the middle finger of your left hand
• Press its distal interphalangeal joint firmly on the surface to be percussed.
Avoid contact by any other part of the hand.
• The right middle finger should be partially flexed, relaxed, and poised to
strike.
• With a quick, sharp, but relaxed wrist motion, strike the pleximeter with
the right middle finger (plexor finger). Aim at your distal interphalangeal
joint.
• Use the tip of your plexor finger, not the finger pad.
• Withdraw your striking finger quickly – to avoid damping.
• Thump about twice in one location.
CONTD.
• The pleximeter should be opposed tightly over the intercostal spaces
and the other fingers should not touch the chest wall.
• Proceed from the areas of normal resonance to the area of impaired
or dull note – the difference is easily appreciated then.
• The long axis of the pleximeter is kept parallel to the organ to be
percussed
CONTD.
The pleximeter finger
The plexor finger
AREAS OF PERCUSSION
• ANTERIOR CHEST WALL:
CLAVICLE: Direct percussion within the medial 1/3rd
INFRACLAVICULAR
2nd to 6th INTERCOSTAL SPACES: However, percussion notes cannot be compared due to
relative cardiac dullness on the left
• LATERAL CHEST WALL: 4th to 7th intercostal spaces
• POSTERIOR CHEST WALL:
Suprascapular
Interscapular
Infrascapular upto 11th rib
KRONIG’S ISTHMUS
• A band of resonance of 5-6cm width in the apex of the lung.
• Percussed medially from the acromioclavicular joints.
• Laterally, marked by a line joining 2 points:
The junction of the medial 2/3rd of clavicle with the lateral 1/3rd
The junction of the medial 1/3rd of scapular spine with the lateral 2/3rd.
• Medially, marked by a line between the sternal end of the clavicle and 7th
cervical spine.
PERCUSSION ON THE RIGHT SIDE
• Liver dullness can be percussed from the right 5th intercostal space downward in
the midclavicular line up to the right costal margin.
TIDAL PERCUSSION:
• Done to differentiate upward enlargement of liver from right sided parenchymal
or pleural disorder.
• On deep inspiration: if previous dull note in the right 5th intercostal on the
midclavicular line becomes resonant, it indicates dullness was due to the liver
which has been pushed down on deep inspiration
• If the dullness persists: Indicates right sided pleural or parenchymal pathology
TRAUBE’S SPACE
2 parallel vertical lines:
• Left 6th CC Jn
• 9th rib in MAL
• Connect above
• Below along left
costal margin
• Semilunar space –
tympanitic on
percussion.
BOUNDARIES
• Right side: Left lobe of liver.
• Left side: Spleen
• Above: Left lung resonance
• Below: Left costal margin
• Content: Fundus of stomach
OBLITERATED IN
• Left sided pleural effusion
• Massive splenomegaly
• Enlarged left lobe of liver
• Fundal growth
• Massive pericardial effusion
• Full stomach
OTHER FEATURES OF CLINICAL IMPORTANCE
• Percussion tenderness: Empyema
• Straight line dullness: Hydropneumothorax
• Shifting dullness: Hydropneumothorax
• “S” shaped curve of Ellis: In moderate sized pleural effusion,
uppermost level of dullness is highest in the axilla and lowest in the
spine and tends to assume the shape of the letter “S”.
THANK YOU