PERCUSSION AND

AUSCULTATION

BY DR.VIDHU MITTAL
JUNIOR RESIDENT
DEPTT. OF CHEST AND TB
 Anterior lung surface markings

• REMEMBER: 2,4,6,8,10 Lungs

• Each lung extends 3cm above
the clavicle (apex)
• Anterior borders of lungs are
closest at the sternal angle –
2nd costal cartilage (cc)
• Both reach to 4thcc
• Left:
– Moves away from the midline
at the 4th cc
• Right:
– Moves away from the midline Note about pleura: They have the
at the 6th cc
same surface markings as the lungs
• Both cross the midclavicular
but reach further down to the 12th cc
line at the 8th cc
REMEMBER: 2,4,6,8,10,12 Pleura
• Both cross the midaxillary line
at the 10th cc
 Percussion
Historical note
Amongst the notable advances of 18th century, one
is the introduction of a new method of clinical investigation
i.e. percussion by “Joseph Leopold Auen brugger in 1761. It
was the simple expedient of tapping the barrels of wine in
his father’s cellar to determine their contents that gave
Auen brugger the idea of percussion of the thorax as an aid
to diagnosis, a discovery first announced in 1761, in his
Inventum Novum.
Definition:
Percussion is a method of examination which
depends on the interpretation of sounds heard and the
sense of resistance encountered on subjecting the chest to
a series of strokes or taps with the fingers .

Main purposes of respiratory percussion :

•Diagnostic Percussion.
•Topographical Percussion.
 Methods of Percussion

Direct Indirect
(immediate) (Intermediate)

•Where the strokes •Where the stroke are

are aimed directly aimed at some
at the chest wall. intermediate object
• Percussion over (e.g. a finger) applied
bony structure. to surface of chest
wall.
The other special types of percussion are:
(a) Light percussion : on the clavicles is useful to
determine the character of the lung substance at
the apices.
(b) Heavy percussion : by using two fingers instead
of one or using several fingers without any
intermediate finger.
(c) Flicking percussion: it is useful for eliciting
metallic resonance in case of pneumothorax.
(d) Direct or indirect palpatory percussion: it may
be used for detecting the presence of fluid or
consolidation within the chest.
TECHNIQUE OF PERCUSSION:
Position of Patient: The patient may be
percussed in the sitting, standing or recumbent
position.
(a) Recumbent position: best avoided
(b) The standing position : tiring both to patient and
examine.
The position of choice is sitting up posture.
 IDEAL POSTURES
Area to be Posture
AUAUSCULTATION OF
percussed
RESPECTIVE
a) Front wall of chestPatients sits on aAREAS
stool opposite the examiner
with the body bolt upright, completely relaxed
and with sides symmetrical

b) Back Patients bends slightly forwards with the head

flexed on the chest, the shoulders sagging and
the arms resting, either crossed or uncrossed,
on the thighs.

c) Interscapular / scapular Patient is directed to place his hands over the

region shoulders after crossing the arms in front of the
chest.

d) Axillae Patient is instructed to put his hands over the

head.
AREAS OF EXAMINATION
Direction of percussion:
It is customary to start percussion to at the apices of
the lungs comparing identical or corresponding area
on 2 sides and slowly proceeding downwards.

Cardinal Rules of Technique:

•The pleximeter, the middle phalanx of the 3rd finger
of the examiner’s left hand must be firmly applied to
the chest wall, so that no air pockets are interposed
between the finger and chest wall.
•The ‘plesser’ which is the third finger of the examiner’s right
hand, is kept flexed at a right angle and must hit the middle
phalanx of the pleximeter finger perpendicularly, with the pad
and not the tip of the finger.
• The percussion stroke must be sudden, the plessor finger
being withdrawn immediately after the stroke, to prevent a
damping of the note.
• The movement of percussion must originate at the wrist and
not at the elbow or finger.
• The force of the stroke must be varied according to the
purpose of the percussion the tissue or organ being percussed ,
thickness of the chest wall or area of the chest wall.
• Percussion should proceed from resonant to dull area or from
more resonant to less resonant areas whenever possible the
auditory appreciation of any change of note being better in this
direction.
• Whenever delineating the border of an organ, such as the
heart or the liver, the long axis of the pleximeter finger must be
kept parallel to the expected position of that border.
• The area percussed must be more or less equidistant from the
two ears of the examiner, in order to prevent wrong
interpretation of sounds; the examiner must therefore directly
face the centre of the patient chest, whenever possible.
Types of percussion notes:

Normal lung resonance (Vesicular resonance) :

The normal percussion note of the chest is due to an
underlying lung tissue, containing a normal amount of air
in the air vesicles, air sacs and air passages which has a
distinctive and clear character with a low pitch.
Abnormal types of percussion notes

Quantitatively Qualitative different

different

• Tympany • Cracked pot resonance

• Subtympany • Amphoric resonance
•Hyperresonance • Bell tympany
•Impairment of note
• dullness
• stony dullness
Tympany : Drum like note.
When such a note in heard once a region of the chest
mall, the possibility of a superficial cavity in the lung or
pneumothorax should be considered.

Subtympany (Skodaic resonance) :

Hyperresonant note with boxy quality.
heard just above the level of a pleural effusion or
pneumonic consolidation .
Hyperresonance: A note intermediate in pitch between
normal lung resonance and tympany which can be elicited
normally by percussing in full inspiration. Pathologically it
can be encountered either
B/L in case of emphysema.
U/L in pneumothorax, large bullae or compensatory
emphysema.
Impaired note : When part of the lung becomes
comparatively airless, it fails to vibrate sufficiently to the
percussion stroke and gives rise to an impairment of note
or loss of resonance.
Flatness (absolute dullness) : A percussion note
completely devoid of resonance a displaying absolute or
extreme dullness in referred to as flat dull notes.

Stony dullness: A type of absolutely dull percussion note

associated with pain when percussing in the examiner’s
pleximeter finger as one would experience when
percussing oves stone.
TYPE OF PERCUSSION SEEN IN
NOTE

Tympanitic Gas containing hollow viscera.

Subtympany Above pleural effusion or
consolidation
Hyperresonant Pneumothorax
Resonant Normal aerated lung
Impaired Pulmonary fibrosis, sometimes
consolidation or collapse.
Dull Thickened pleura, consolidation,
collapse
Flat Pleural effusion
Stony dull Massive growth in lung or pleura
 OTHER ABNORMAL
PERCUSSION NOTES

• Cracked pot resonance: tympanic resonance which is due to

the sudden expulsion of air from the cavity into the bronchus
through the narrow opening or communication.

• Amphoric resonance: A low pitched and hollow note that can

be elicited in pneumothorax or large cavity in the lung.

• Bell tympany
 Topographic Percussion of
Lungs
• Percussion of the chest to determine the
boundaries or extent of lungs is referred to
as topographic percussion . It can be :-
• APICAL percussion
• BASAL percussion
• TIDAL percussion
Apical percussion: Can be carried out in the
supraclavicular fossae anteriorly by determining the upper
borders of lung resonance on the two sides.

•decreased/absent supraclavicular • good evidence of

zone of resonance on one or pulmonary tuberculosis.

Both side.

• increased extent of resonance •emphysema

bilateral suggests.
An alternative method:
Kronig’s isthmus :- which is a band of 5-7cm in width of
resonance connecting the large zones of lung resonance
over the anterior and posterior aspects of each side.

Decreased / absent Suggestive of apical

kronig’s istmus tuberculosis
Increase in width Suggestive of emphysema
.
Basal Percussion:
• Percussion of lower border of the lung necessitates light
percussion anteriorly and heavy percussion at the back
(because of thicker musculature)
• A change of note from vesicular resonance to dullness
(posteriorly, on both sides and anteriorly, on the right side).
• From vesicular resonance to tympany when percussing
downwards over the chest, serves to delineate the lower or
basal limit of lung resonance
Applied : lower border of the lung resonance tends to be
depressed in case of emphysema or pneumothorax raised in
case of lung fibrosis, collapsed lung, consolidation, ascites,
massive abdominal tumor or pleural effusion.

Tidal percussion: Percussion of the lower border of lung

resonance, on each side, at the height of deep inspiration
and expiration serves to determine the extent of
diaphragmatic excursion.
decreased or restricted movement suggests some underlying
lung disease such as pulmonary fibrosis.
Areas of abnormal percussion note in health:

• Area of cardiac dullness.

• Area of liver dullness.

• Area of splenic dullness

• Traube’s area.

• Ewart’s sign
Special Percussional findings in disease:
• Reduction of both cardiac and liver dullness.
• Shifting dullness.
• Obliteration of Traube’s area.
• William’s tracheal resonance.
• Wintrich’s sign
• Gerhardts’ sign
• Friedreich’s sign
• Lines of Demarcation
• Myotatic irritability.
AUSCULTATION
 HISTORICAL NOTE
A discovery of the greatest importance in the
early part of 19th century was that of
auscultation with the aid of stethoscope by
the French physician LAENNEC .
Remembering a well known acoustic fact that
“ if the ear be applied to one end of a plank , it
is easy to hear a pin’s scratching on the other
end .”
 UNAIDED EAR
TYPE OF SOUND FOUND IN
1- STERTOROUS breathing coma and sleep( snoring)
2- RATTLING breathing ineffective cough due to suppression of
cough reflex
3- GASPING , GRUNTING and SIGHING physical and emotional stimuli- exercise ,
pain, cold fear , grief
4-HISSING ( KUSSMAULS ) breathing signifies hyperventilation without
dyspnoea.
sign of severe acidosis as in diabetic keto
acidosis
5-WHEEZING asthma
6- STRIDOR narrowing of extrathoracic airway
 OBJECTIVES OF AUSCULTATION
• To determine whether the breath sounds are
equal on both sides .
• To ascertain the character of the breath
sounds .
• To detect any added sounds and decide their
nature and whether they are intra or
extrapulmonary.
• To compare the voice sounds on different
parts of lungs.
 METHOD OF BREATHING
Patient is asked for forced or deep breathing ,
through the mouth as this increases the tidal
volume sufficiently without producing
additional upper airway noise or provoking
hypocapnia .
 DEFECTIVE AUSCULTATION OF
RESPIRATORY SOUNDS
Auscultation may be defective if the patient is
• Breathing through the nose , especially in the
presence of nasal obstruction.
• Breathing noisily or too forcibly giving added
sounds .
• Shallow breathing due to pain on breathing .
• Hair on the chest produces crackling sounds
which may be mistaken for lung sounds .
 POSITION OF THE PATIENT
• Ideal posture - upright , either sitting or
standing
• For examination of the back – patient may
lean slightly forward , with the head flexed
arms crossed in front or resting on the thighs .
• Examination in the recumbent position
although undesirable but may be required in
seriously ill patient .
 FEATURES TO NOTE DURING
AUSCULTATION OF BREATH SOUNDS

• Intensity or loudness.
• Quality or character whether rustling or wheezy .
• Comparison of inspiratory and expiratory elements in
terms of intensity , duration or length and pitch.
• Presence or absence of intermediatory pause between
them .
• Characteristics such as prolongation or jerky or
interrupted nature .
• Presence of other sounds or accompaniments
 FACTORS DETERMINING
TRANSMISSION OF BREATH SOUNDS
The intensity of the breath sounds heard
through the chest wall depends on :-
• rate of airflow into the territory of lung under
the stethoscope .
• The acoustic properties of the two media
namely the lung and the chest wall .
 Therefore..
• Transmission is almost • Sound is reflected at
complete between the the interface between
two well matched the lung and air or fluid
media like consolidated in the pleural cavity so
lung and the chest wall that in pneumothorax
,hence the similarity and in pleural effusion
between the bronchial no breath sounds
breathing and the reaches the chest wall
breath sounds heard
over the trachea .
MODE OF PRODUCTION OF NORMAL
BREATH SOUNDS
Normal breath sounds are generated by turbulent
airflow in the upper airways i.e. in the pharynx and
larger airways of the lugs ( frequency range of 200 to
2000 Hz or cycles / sec per sound )
As this sound is transmitted through the lungs it is
dampened ; the higher frequencies are lost and a
softer , lower pitched sound ( 200 to 400 Hz ) is heard
, which are the normal vesicular breath sounds. In the
smaller airways airflow is slow and laminar ,
turbulence cannot be developed hence smaller
airways acts as filter and not a source of lung sounds .
 TYPES OF NORMAL BREATH SOUNDS
TYPE OF SOUND AREA WHERE FOUND

VESICULAR Over most areas of the chest

BRONCHIAL Larynx , trachea

BRONCHOVESICULAR Over and around the upper part of the

sternum
 VESICULAR BREATH SOUNDS
It is characterised by active inspiration due to
inflow of air into bronchi and alveoli followed
without a pause by passive expiration from elastic
recoil of the alveoli.
QUALITY :- rustling noise
louder and more prolonged in inspiration than
expiration.
MODE OF PRODUCTION :- It is attributed to
distention and separation of the alveolar walls by
the in-rushing current of air .
 BRONCHIAL BREATHING
The less the filtering of the breath sounds the more closely
will the sound approximate to its source in the trachea and
bronchi i.e. is bronchial breathing .
QUALITY :- higher pitched and clearer than vesicular
breathing .
Inspiration and expiration are of equal length or expiration
is somewhat longer than inspiration and they have a
distinct gap between them .
MODE OF PRODUCTION :- Due to the in and out movement of
the air through the narrow aperture of the glottis . The
lower pitch of the sound during inspiration is due to the
glottic aperture being wider during inspiration because of a
wider separation of vocal cords .
 BRONCHOVESICULAR BREATHING
Its a type of breathing intermediate in character in
between vesicular and bronchial breathing . Its
recognition usually depends on the nature of the
expiratory sound which is louder , longer and
higher in pitch than the inspiratory sound .
MODE OF PRODUCTION :- it usually arises when the
normal air containing lung tissue is interposed
between a large bronchus and the chest wall ,
thus combining the characteristics of both
vesicular and bronchial types of breathing .
 ABNORMAL BREATH SOUNDS
Breath sounds may be heard abnormal due to
two main reasons :-

ABNORMAL GENERATION ABNORMAL CONDUCTION

Narrowed airways intensify the Abnormal lung will conduct the

linear velocity of breath sounds centrally generating breath sounds
and thus increasing their abnormally for e.g. consolidated
turbulence making the breath lung and the overinflated lung of
sounds louder . emphysema.
 ABNORMAL TYPES OF VESICULAR
BREATHING
ABNORMALITY PHYSIOLOGICALLY SEEN IN PATHOLOGICALLY IN

1- Exaggerated or loud • children Bilaterally in states of

breath sounds •Thin chested individuals dyspnoea or bronchitis
•In women unilaterally in pulm. Tb or
compensatory emphysema

2-Diminished or feeble • habitual shallow -Defective production of

breathers respiratory sounds
•During quiet breathing --defective conduction of
•Thick chest wall respiratory sounds .
•obesity

3-Absent breath sounds Massive pleural effusion ,

pneumothorax , area of
lung collapse , secondary
occlusion of a bronchus
 ABNORMAL TYPS OF BRONCHIAL
BREATHING
TYPE OF QUALITY CAN BE IMMITATED SUGGESTIVE OF
BREATHING /CHARACHTER BY
Cavernous Low pitched with Auscultating at Underlying cavity in
hollow character occipital region of the lung
skull Open
pneumothorax
Pulled trachea
syndrome
Tubular High pitched with Pneumonia
tubular or aspirate Pulm infarction
quality Atelectasis or
collapse of lung
Amphoric High pitched with Blowing intensely Large cavity in the
metallic or ECHO across the mouth of lungs with smooth
like quality the bottle walls
Pneumothorax
communicating
with the bronchus
 ABNORMAL BRONCHOVESICULAR
BREATH SOUNDS
METAMORPHOSING breath sounds :-
occasionally , the type of breathing may
change suddenly in type, character or
intensity during one and the same breath . It is
usually due to dislodgement of a mucus plug
that is partially occluding a bronchus , by the
incoming rush of air during inspiration .
 ADVENTITIOUS (ADDED) SOUNDS
Chest diseases can give rise to 3 types of added
sounds , namely :-
• Wheezes
• Crackles
• Pleural friction
 WHEEZES
These are continuous musical sounds caused by flow
through narrowed airways .
MODE OF PRODUCTION :- as air is forced past a point at
which opposing airway walls are just touching ; these
vibrate , generating the wheeze .
TYPES OF WHEEZES:-
1- Fixed monophonic wheeze – this is a single note of
constant pitch , timing and site . It results from air
passing at high velocity through a localized narrowing
of one airway . Bronchial carcinoma is the commonest
cause
2 Random monophonic wheeze :- these are random
single notes which may be scattered and overlapping
throughout inspiration and expiration and are of
varying duration , timing and pitch . They signify
widespread airflow obstruction as in asthma or
bronchitis .
POLYPHONIC WHEEZES
• Expiratory polyphonic wheeze :-it results from the
oscillation of several large bronchi simultaneously
brought to the point of closure by congestion of the
mucus lining , contraction of smooth muscle and
thickening of layer of mucus . E.g. in asthma and COPD.
• SEQUENTIAL INSPIRATORY WHEEZES
( SQUAWKS ):- A series of sequential but not
overlapping inspiratory sounds or
occasionally a single sound , resulting from
opening of airways which had become
abnormally apposed during previous
expiration . They tend to occur in deflated
areas of lung and hence are heard in lung
fibrosis , especially fibrosing alveolitis .
 a) Fixed monophonic wheeze
b) Random monophonic wheeze
c) Expiratory polyphonic wheeze
d) Sequential inspiratory wheeze(squakes)
 CRACKLES
Crackles result from the explosive equalization
of gas pressure between two airway
compartments when a closed section
between them suddenly opens . Expiratory
closure of airways is gravity dependent , so
that crackles are mainly basal in site .
Classification of crackles
Acc. to timing
Conventional
& character

Early
Coarse
inspiratory

Late
Fine
inspiratory

Expiratory
EARLY INSPIRATORY CRACKLES :-
• Are coarser
• Come from larger airways so pattern is same
over different parts of the lung .
• are scanty , audible at the mouth and not
posture dependent.
 LATE INSIPIRATORY CRACKLES
• Are due to restrictive conditions of the lung
resulting in expiratory closure of small peripheral
airways with re-opening at the end of inspiration .
• Come from smaller airways so have fine pattern
and varies over small areas of the lung .
• Dependent on the gravitational forces on the lung
so best heard at lung bases where the small
airways close on expiration.
 EXPIRATORY CRACKLES
• They arise by re-opening of the airways ,
temporarily closed by the trapping mechanism
as air is redistributed distal to larger and more
proximal airways narrowed by the trapping
mechanism during expiration .
• They are characteristic of severe airway
obstruction .
 COVENTIONAL CLASSIFICATION OF
RALES
1. COARSE CRACKLES :- they originate within large
bronchial tubes and are heard equally in
inspiration and expiration.
. Are often altered with coughing and can be
heard over segments and lobes affected with
bronchiectasis.
. May also be heard at the mouth without
stethoscope and are caused by air bubbling
through collections of mucus or pus in areas of
bronchiectasis.
 FINE CRACKLES
• Are due to sudden separation of sticky
alveolar walls , at the end of inspiration by the
inrushing of air .
• These lack the bubbling quality of coarse
crackles and have “crackling” quality .
• These may be artificially imitated by rubbing a
lock of hairs between the finger and the
thumb.
PLEURAL RUB ( PLEAURAL FRICTION )
Definition :- oscillations arising from the
frictional resistance between two layers of
inflammed or roughened pleura produce a
creaking sound ; the pleural friction rub .
SITE OF AUSCULTATION :- commonest site is
lower part of axilla as movement of two layers
of pleura is maximum in this area .
 CHARACTERISTICS OF PLEURAL RUB
• Rubbing or creaky in quality
• Interrupted or jerky in nature
• Loud and superficial
• Audible during both phases of respiration
• Unaltered after bouts of cough
• Usually confined to small or localized area on
chest.
• Usually associated with pain and tenderness.
 PLEURAL RUB AND CRACKLES :
COMPARISION
PLEURAL RUB CRACKLES
• Superficial and loud . • Not so superficial and loud
• Continuous sound. • Interrupted sound
• Heard over a localized area. • Heard over a wide area
• Remains unaffected by • Intensified or abolished by
coughing.
coughing
• Pressure of chest piece of
stethoscope intensifies the • Pressure of chest piece
sound. produces no effect
• Associated with pain or
local tenderness. • No pain or local tenderness
 MISCELLANEOUS SOUNDS AND SIGN
1. Succussion splash:- Splashing sound heard
when the chest of the patient is shaken
suddenly by the examiner . It can be seen in
•Herniation of stomach or colon into the thoracic cavity
•Hydro or pyopneumothorax

2. Clicking sounds :- A small left sided

pneumothorax may at times give rise to
clicking sounds in tune with the heart beat.
3. Mediastinal crunch :- it may result from sudden
movement of air by the systolic contraction of
the heart or sudden contact and separation of
the two pleural layers . Seen in .
mediastinal emphysema
bullous emphysema of lingula
4. Forced expiratory time :- normally it takes less
than 4 seconds . A value of 6 seconds or more
indicates airway obstruction.
VOICE SOUNDS ( VOCAL RESONANCE)
• It is the auscultatory equivalent of the palpatory
phenomenon of tactile vocal fremitus .
• MODE OF PRODUCTION :- vibrations initiated by
the spoken voice or whispered voice are
transmitted along the air passages and through
the lung parenchyma to the chest wall , resulting
in certain auditory or auscultatory sound
phenomenon refered to as either spoken voice
sounds or whispered voice sounds.
 SPOKEN VOICE SOUNDS
( CONDUCTED)
TECHNIQUE :- while auscultating the patient is
made to repeat over and over again , in a slow,
loud, uniform and deep voice some phrase
such as ‘ninety-nine’ or ‘ one-one-one’ or
‘one-two-three’.
Normal – sounds heard are weak , muffled
and indistinct with blurred and
indistinguishable individual syllable.
• Physiological variations :- depends on factors like
1. age
2. sex
3. state of nutrition
• Regional variations :-
. Louder on right than left
. Louder anteriorly than posteriorly
 SPOKEN VOICE SOUNDS IN DISEASE

INCREASED VR DECREASED VR

• Consolidation • Partial laryngeal stenosis

• Infilteration of lung tissue • Thickened pleura
• Bronchiectasis • Small pleural effusion
• Compensatory emphysema • Edema of chest wall
 ABSENCE OF VR
ABSENCE OF PRODUCTION ABSENCE OF CONDUCTION

• Deaf- mutism • Large pleural effusion

• Vocal cord paralysis • Severe emphysema
• Pneumothorax
• Acute pulmonary edema
 BRONCHOPHONY
When spoken voice sounds appear unduly loud ,
clear with individual words or syllables
however remaining indistinguishable.. Its
presence indicates:-
. Lung consolidation
. Compressed lung tissue as
in pleural effusion.
. Tuberculous or
bronchiectatic lung cavity
 SPOKEN PECTORILOQUY
• When spoken voice sounds appear unduly
loud , clear and syllabic individual words being
clearly distinguishable . It may be seen in :-
. Large cavity in the lung
communicating with the bronchus
. Obstruction of a large bronchus
by the tumor
 AEGOPHONY
• When the spoken voice sounds during
auscultation display a peculiar quivering ,
nasal quality like the “ bleating of goat “, the
condition is referred as aegophony .
• It can be initiated by saying ‘ ninety – nine ‘
while holding one’s nose. It may be seen in
. Pleural effusion
. Cavity half filled with secretion .
AMPHORIC VOICE SOUNDS( ECHOING
RESONANCE)
• When spoken voice sounds besides being intense
and clear , display a characteristic metallic ,
echoing sound , they are referred as amphoric
voice sounds .
• They may be seen in :-
. Large cavity with tense or rigid
walls communicating with
bronchus
. Over open pneumothorax
 THE SCRATCH SIGN
• It is useful in diagnosis of pneumothorax
• It is elicited by placing the stethoscope at
some midline position on the chest and
equidistant from it on both sides the skin is
scratched with finger or blunt object and the
sound from the two sides is compared.
• Positive sign – louder and harsher sound on
the side of pneumothorax .
 WHISPERED VOICE SOUNDS
• Sounds heard over the chest wall during the act
of whispering by the patient.
• MODE OF PRODUCTION :- here the phenomenon
of articulation takes over the entire function of
sound production . Also there is no vibratory
tremor and sympathetic vibration on the part of
the thoracic walls .
• METHOD OF ELICITING :- patient is asked to
whisper phrases like ‘one-one-one’, ‘one –two-
three’.
 WHISPERED SOUNDS
IN HEALTH IN DISEASE

• Usually inaudible over • Consolidation

normal lung parenchyma • Bronchopneumonia
• Tuberculous infilteration
 WHISPERED PECTORILOQUY
• It is when the whispered voice is transmitted to
the chest wall with sufficient clarity and
individual syllables or words being clearly
distinguishable .
• It may be indicative of :-
. Fairly large cavity in the lung
communicating with a bronchus
. Massive or diffuse consolidation of
lung tissue overlying or adjacent to bronchus
. Obstruction of a large bronchus by a
tumor.
 SUMMARY
DISEASES PERCUSSION BREATH VOICE ADDED
NOTE SOUNDS SOUNDS SOUNDS
CONSOLIDATIO DULL BRONCHIAL BRONCHOPHO FINE
N NY INSPIRATORY
WHISPERING CRACKLES
PECTORILOQUY

COLLAPSE DULL ABSENT OR DIMINISHED NONE

BRONCHIAL OR
BRONCHOPHO
NY

FIBROSIS DULL DIMINSHED OR DIMISHED OR COARSE

BRONCHIAL BRONCHOPHO CRACKLES( IF
NY BRONCHIECTAT
IC)
DISEASES PERCUSSION BREATH VOICE SOUNDS ADDED
NOTE SOUNDS SOUNDS
EMPHYSEMA HYPERRESONA DIMINISHED DIMINISHED EXPIRATORY
NCE,, LOSS OF WHEEZE
LIVER AND
HEART
DULLNESS

EFFUSION FLAT OR STONY DIMINISHED DIMINISHED FRICTION

RUB(IN EARLY
STAGES)

PNEUMOTHOR TYMPANY DIMINISHED DIMINISHED METALLIC

AX OR AMPHORIC CRACKLES