Tactile Fremitus

Increased Decreased

Pneumonia Unilateral

Pneumothorax Pleural effusion Bronchial obstruction

Atelectasis (incomplete expansion of lungue tissue)

Bilateral

Chronic obstructive heart disease Chest wall thickening

Causes of dullness to percussion

Moderate

•Consolidation

•Fibrosis

•Collapse

‘Stony’

• Pleural fluid

Points to note on auscultation of the chest.

•Vesicular breath sounds

•Bronchial breath sounds

•Vocal fremitus and resonance

–bronchophony

–whispering pectoriloquy

–aegophony

Added sounds

–pleural rub

–wheezes

–crackles

Causes of crackles

•Left ventricular failure

•Fibrosing alveolitis

•Extrinsic allergic alveolitis

•Pneumonia

•Bronchiectasis

•Chronic bronchitis

•Asbestosis