Terms Associated with Respiratory Percussion &
- Dullness — Associated with lobar
pneumonia, where the alveoli are filled with fluid . It has a medium
intensity, pitch and duration (e.g., normal liver). The
dullness replaces the normal resonance because fluid or tissue has filled
the lung or pleural air space. Other pathological examples of dullness
include, pleural effusion (accumulation of serous fluid in the pleural
space), hemothorax (blood), empyema (pus), and other changes like fibrosis
Because pleural fluid sinks to the lowest part of the pleural space, it may
be very difficult to percuss anterior dullness in a supine patient; unless
it is a very large effusion.
Right middle lobe pneumonia typically occurs behind the right breast. In a
female patient, it is very important to displace the breast in order not to
miss the related dullness.
- Flatness — Associated with a large
pleural effusion. It has a soft intensity, high pitch and short duration (e.g.,
- Fremitus — Palpable
vibrations transmitted through the bronchopulmonary tree to the chest wall
when the patient speaks. Use the bony part of your palm to feel the chest
for vibrations. Ask the patient to repeat the words "ninety-nine."
Fremitus is more prominent in the interscapular area, and more on the right
than the left side. Examine midclavicular 2nd & 4th intercostal spaces,
and anterior axillary 4th intercostal space.
Fremitus is decreased when the vibrations are not transmitted from the
larynx to the chest wall. May be due to an obstructed bronchus, COPD,
pleural effusion, fibrosis, pneumothorax, or an infiltrating tumor.
Fremitus is increased when there is increased transmission of vibrations.
This is most often associated with the consolidated lung of lobar
- Hyperresonance — A
generalized/bilateral hyperresonance is associated with an over inflated
lung, as seen with emphysema or asthma (not very reliable). On the
other hand, a unilateral hyperresonance is associated with a pneumothorax
(see tympany). This sound quality can not be percussed over any normal body
part. It has a very loud intensity, very low pitch, and long duration.
In emphysema, the hyperresonance may completely replace normal cardiac
- Resonance — Associated with either
a normal lung or a simple chronic bronchitis. It has a very loud intensity,
low pitch and long duration.
- Tympany — Associated with a very
large pneumothorax. It has a loud intensity, high musical pitch, and
long duration (e.g., gastric air bubble or puffed cheeks!).
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