Anatomca considerations

The regions of the thorax over which a resonant percussion note is normally found correspond approximately to the surface marking of the lungs (Fig. 4.11). Percussion over the heart or the liver will elicit a dull note, but the area of dullness is less extensive than would be expected from anatomical surfacc markings, since aerated lung is interposed between part of the viscus and the chest wall.

TABLE 4.17 Percussion note

Type

Detected over

Tympanitic

Hollow viscus

Hyperresonant

Pneumothorax

Resonant

Normal lung

Impaired

Pulmonary consolidation Pulmonary collapse Pulmonary fibrosis

Dull

Pulmonary consolidation Pulmonary collapse Pulmonary fibrosis

| Stony dull

Pleural effusion

Technique Percussion Thorax

Examination sequence

The basic technique of percussion for a right-handed clinician is as follows:

□ Place the left hand on the chcst wall, palm downwards, lingers slightly separated with the sccond phalanx of the middle finger over the area to he percussed, usually an intercostal space.

□ Firmly press the left middle tingcr againsl ihe chest wall.

□ Strike the ccntrc of the second phalanx with the tip of the right middle finger held at a right angle (to produce a 'hammer' effect) and with the entire movement coming from the wrist joint (Fig. 4.16).

□ Compare the note obtained from identical sites on the two sides.

□ Map oul any area of impaired resonance (including cardiac and hcpatic dullness, p. 167) by percussing from a resonant to a dull area.

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