In a woman, to enhance percussion, gently displace the breast with your left hand while percussing with the right.
The dullness of right middle lobe pneumonia typically occurs behind the right breast. Unless you displace the breast, you may miss the abnormal percussion note.
Alternatively, you may ask the patient to move her breast for you. Identify and locate any area of abnormal percussion note.
With your pleximeter finger above and parallel to the expected upper border of liver dullness, percuss in progressive steps downward in the right mid-clavicular line. Identify the upper border of liver dullness. Later, during the abdominal examination, you will use this method to estimate the size of the liver. As you percuss down the chest on the left, the resonance of normal lung usually changes to the tympany of the gastric air bubble.
A lung affected by COPD often displaces the upper border of the liver downward. It also lowers the level of diaphragmatic dullness posteriorly.
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