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Local Chest Examination AMM2

This document provides an overview of the local examination of the chest, including inspection, palpation, percussion, and auscultation. Inspection assesses the shape of the chest, symmetry of movement, skin changes, and pulsations. Palpation evaluates tenderness, tactile vocal fremitus, and pulsations. Percussion determines the lung borders and identifies areas of dullness or hyperresonance. Auscultation identifies breath sounds, adventitious lung sounds, and evaluates vocal resonance over the chest. The examination provides information to identify abnormalities of the chest wall, lungs, pleura, and mediastinum.

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367 views37 pages

Local Chest Examination AMM2

This document provides an overview of the local examination of the chest, including inspection, palpation, percussion, and auscultation. Inspection assesses the shape of the chest, symmetry of movement, skin changes, and pulsations. Palpation evaluates tenderness, tactile vocal fremitus, and pulsations. Percussion determines the lung borders and identifies areas of dullness or hyperresonance. Auscultation identifies breath sounds, adventitious lung sounds, and evaluates vocal resonance over the chest. The examination provides information to identify abnormalities of the chest wall, lungs, pleura, and mediastinum.

Uploaded by

saeedoof
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 37

Local Examination

Of The Chest

Ashraf Madkour, MD, Dr.med., FCCP


Chest department - Ain Shams University

[email protected]

Page  1
Local Examination of the Chest:

• Inspection
• Palpation
• Percussion
• Auscultation

Page  2
Inspection:

1-Shape of the chest.


2-Movement
3-Symmetry
5-Skin
•Pulsations
•Scars, Dilated veins or Pigmentation
7-Subcostal angel
8-Special signs
Page  3
Local Examination of the Chest
Inspection:

1- Shape of the Chest:

• Normal Shape
• Elliptical/bilaterally symmetrical /freely mobile/oblique ribs /subcostal angle
70-110 º

• Barrel shaped chest


•  AP T diameter/ bilaterally symmetrical / diminished expansion/ prominent
sternum /transverse ribs /subcostal angle obtuseº

• Pigeon chest
• Rachitic chest
• Funnel-shaped chest (Pectus Excavatum)
Page  4
Page  5
Barrel Chest

AP Diameter = Transverse
Diameter

Page  6
Shape: Pectus Excavatum

Page  7
Shape: Pigeon Chest

Page  8
Movement:

Equality:

Compare clavicles, nipples, costal margins, spine of scapulae (post.)


The less mobile side or site is the diseased one
e.g. Equal movement on both sides or
Decreased movement on (site- {e.g. right inframammary})

Movement is decreased in all diseases of chest


Unilateral ………. Or bilateral………………….

Expansion:
N → 4-6cm max insp. & max exp.  2 cm→ pathological
e.g. Normal expansion or decreased expansion

Page  9
Movement:
Rate: e.g. 16 breath per minute.

Pattern of breathing:
e.g. thoracoabdominal or Abdominothoracic

Rhythm:
e.g. normal regular rhythm or irregular rhythm.

Page  10
Symmetry :

• Normal chest: symmetrical on both sides


• The diseased side or site got limited
movement.
• Bulge: chest wall…., Pleura…., lung…..,
mediastinum….
• Retraction: Pulmonary collapse , Pulm. Fibrosis,
Pleural fibrosis, ……..

Page  11
Symmetry :

e.g. Symmetrical on both sides


or
Asymmetrical  type: Bulge or Retraction
 Site: e.g. left inframammary

Page  12
Skin:
• Scars, Dilated veins or Pigmentation
• e.g. no scars, dilated veins or pigmentation

SVC Obstruction

Page  13
Pulsations:
 Apical
 Epigastric
 Other pulsations
e.g.
Apex: Apical pulsation is visible in (site) or
invisible.
Epigastric: Epigastric pulsation is visible or
invisible.
Other pulsations
Page  14
Palpation:

•Tenderness:
•Movement
•Tactile vocal fremitus (TVF)
•Palpable adventitious sounds
•Pulsations
•Trachea:

Page  15
Palpation:

Movement:
Front: infraclavicular, mammary, inframammary.
Back: scapular, infrascapular

e.g. Equal movement on both sides or


Decreased movement on (site- {e.g. right
inframammary})

Page  16
Movement:

Page  17
Movement:

Page  18
Causes of decrease of chest wall movements :

Unilateral ↓ of chest wall movements:


•Pleural effusion
•Empyema
•Pneumothorax
•Pulmonary consolidation
•Pulmonary collapse
•pulmonary fibrosis
Bilateral ↓ of chest wall movements:
•Bronchial asthma
•Emphysema
•Diffuse pulmonary fibrosis
Page  19
TVF

 TVF: Palpable vibration of sound.


 Intensity depends on:
– Nature of conducting media( √ consolidation)
– Nº of media (no of media→  TVF due to reflection & deflection of vibration)
– Diameter of conducting tube.

Page  20
TVF

 TVF  TVF

 Consolidation (nature of media)  Pleural effusion (Nº of media)


 Cavitation (Nº of media)  Pneumothorax (nature of media)
 Collapse with patent main  Emphysema (nature of media)
bronchus (Nº of media)  Collapse (Diameter of conducting
tube)

Page  21
Palpable Adventitious Sounds

Palpable adventitious sounds


e.g. Palpable adventitious sounds or
No palpable adventitious sounds.

Palpable Pleural Rub

Page  22
Pulsations

Pulsations
Apex: (site)
Others:

Page  23
Position of the Trachea:

e.g. Central or shifted to (right or left)


Page  24
Position of the Trachea:

Ipsilateral Contralateral
Causes of deviation of the trachea
(To pull) ( To push)

 Collapse  Apical mass


 Fibrosis  Pleural effusion
 Pneumothorax

Page  25
Percussion:Technique

Page  26
Percussion - technique
 Hyperextend middle finger and place IP joint firmly against patients chest
(pleximeter)
 Finger // to border percussed
 Tap with Rt middle finger (plexor)
 Movement  from wrist
 2-3 taps & do not damp
 Same: plexor, pleximeter, force & space on either sides
 Start from healthy side
 Percussion notes: normal resonance/impaired note/ dull / stony
dullness/hyper-resonant (
( resonance)/ tympanitic resonance

Page  27
Percussion: Anterior Chest

Page  28
Percussion: Posterior Chest

Page  29
Percussion:

 Upper border of liver is in the (e.g. 5th ) intercostal space in Midcalvicular line
(MCL).
 Bare area of heart is (dull or resonant)
 Kronig`s isthmus is (dull or resonant)
 Traub`s area is (tympanatic or resonant or dull)
 Comparative percussion of the lungs
– Front  MCL, Midaxillary line (MAL) (Rt & Lt)
– Back  Paravertebral then scapular line(SL)over suprascapular, scapular, upper &
lower interscapular areas and infrascapular areas
 e.g. By comparative percussion there is Normal resonant note on both side in MCL,
MAL& SL.
 Diffuse area of stony dullness over (Site/e.g. Rt lower axillary & infrascapular areas)
 Impaired note over (Site /Lt infraclavicular area)

Page  30
Percussion:

 Tidal percussion (Rt & LT)


e.g. Positive tidal percussion (mobile diaphragm)
immobile diaphragm (Rt or Lt)
 Direct percussion over bony prominences
– Clavicle , sternum, spines of scapula, spines
 for tenderness or percussion note changes
e.g. no tenderness or percussion note changes.
  Shifting dullness
Done in presence of diffuse dullness only
e.g. positive or negative test.

Page  31
Auscultation:

 Intensity of breath sounds


 Character of breath sounds
 Adventitious sounds
 Vocal resonance (Confirmatory signs of bronchial breathing)

Page  32
Auscultation:
•Breath sounds
Intensity of breath sounds
e.g. equal intensity of breath sounds or
Generalized decrease of intensity of breath sounds.

or

Decrease of intensity of breath sounds over (Site/e.g. Rt


lower axillary area). Or

Absence of intensity of breath sounds over (Site/e.g. Lt


lower axillary area).

Page  33
Auscultation:

Character of respiratory sounds


e.g. Vesicular breathing
Harsh Vesicular breathing
Bronchial breathing

Page  34
Auscultation:
 Vocal resonance (Confirmatory signs of
bronchial breathing):

•Bronchophony (present or absent)

•Whispering pectoroliquy
(present or absent)

•Aegophony E→A (present or absent)

Page  35
Auscultation:

Adventitious sounds
Site: Generalized or localized (e.g. Rt
upper axillary area).
Timing: Inspiratory or expiratory or
both
Type:
e.g. Sibilant or sonorous ronchi or
both
Fine or coarse crepitations
Pleural rub

Page  36
Page  37

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