Locations For Percussion And Auscultation

Dullness replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers. Examples include: lobar pneumonia, in which the alveoli are filled with fluid and blood cells; and pleural accumulations of serous fluid (pleural effusion), blood (hemothorax), pus (empyema), fibrous tissue, or tumor.

Generalized hyperresonance may be heard over the hyperinflated lungs of emphysema or asthma, but it is not a reliable sign. Unilateral hyperresonance suggests a large pneumothorax or possibly a large air-filled bulla in the lung.

Identify the descent of the diaphragms, or diaphragmatic excursion. First, de- An abnormally high level suggests termine the level ofdiaphragmatic dullness during quiet respiration. Holding the pleximeter finger above and parallel to the expected level of dullness, percuss downward in progressive steps until dullness clearly replaces resonance. Confirm this level of change by percussion near the middle of the hemothorax and also more laterally.

pleural effusion, or a high diaphragm as in atelectasis or diaphragmatic paralysis.

Percuss Lungs

Note that with this technique you are identifying the boundary between the resonant lung tissue and the duller structures below the diaphragm. You are not percussing the diaphragm itself. You can infer the probable location of the diaphragm from the level of dullness.

Now, estimate the extent ofdiaphragmatic excursion by determining the distance between the level of dullness on full expiration and the level of dullness on full inspiration, normally about 5 cm or 6 cm. This estimate does not correlate well, however, with radiologic assessment of diaphragmatic movement.

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  • martin
    Where to auscultate lateral chest lung?
    7 years ago

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