Chest Examination - percussion

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The character of the sound produced by percussion of the chest wall is important in the examination of the respiratory system.
For a right-handed examiner:
  1. the middle finger of the left hand is placed firmly on the chest wall of the patient
  2. the middle phalanx of the left middle finger is struck by the middle finger of the right hand
  3. the palm and other fingers are lifted clear of the chest to prevent any damping of the vibrations
  4. both sides of the chest should be percussed
  5. thought should given to the surface anatomy of the lungs
  6. the two sides of the chest are compared
  7. if an area of dullness is found then its limits are demarcated by percussing from a resonant to a dull area
Changes in resonance are seen in the following conditions:
  1. increased resonance:
    1. emphysema
    2. pneumothorax
  2. decreased resonance:
    1. consolidation
    2. collapse
    3. abscess
    4. neoplasm
    5. fibrosis
  3. stony dull:
    1. pleural effusion

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