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456 PHYSICAL EXAMINATION
A. Anterior thorax
B. Posterior thorax
C. Right lateral thorax
D. Left lateral thorax
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UNIT 2
8
9
1 2
4
5
General percussion
Figure 13.18 demonstrates the percussion pattern for the anterior, posterior, right
lateral and left lateral thoraxes.
2
1
3
6
7
10
12
3
4
6
5
7
8
10
9
11
2
4
FIGURE 13.18 Percussion patterns
FIGURE 13.19 Consumer position for
posterior percussion
1
3
1
2
3
4
To perform anterior thoracic percussion:
E
1. Place the consumer in an upright sitting position with the shoulders back.
2. Percuss two or three strikes along the right lung apex.
3. Repeat this process at the left lung apex.
4. Note the sound produced from each percussion strike and compare the
sounds. If different sounds are produced or if the sound is not resonant, then
pathology is suggested.
5. Move down approximately 5cm, or every second ICS, and percuss in that area.
6. Percuss in the same position on the other side.
7. Continue to move down until the entire lung has been percussed.
To perform posterior thoracic percussion:
E
1. Place the consumer in an upright sitting position with a slight forwards tilt.
Have the consumer bend the head down and fold the arms in front at the
waist. These actions move the scapula laterally and maximise the lung area
that can be percussed (Figure 13.19).
2. Percuss the right lung apex located along the top of the shoulder.
Approximately three percussion strikes should be struck along this area.
3. Repeat the process on the left lung apex.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
RESPIRATORY 457
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E
4. Note the sound produced from each percussion strike and compare the
sounds. If different sounds are produced or if the sound is not resonant,
then pathology is suggested.
5. Move down approximately 5cm, or every second ICS, and percuss in
that area.
6. Percuss in the same position on the contralateral side.
7. Continue to move down the thorax until the entire posterior lung eld has
been percussed.
To perform lateral thoracic percussion:
E
1. Place the consumer in an upright sitting position, with hands and arms
raised directly overhead. This position allows for the greatest exposure of
the thorax.
2. Either percuss the entire right lateral thorax and then the entire left lateral
thorax, or alternate right and left sides. Start to percuss in the ICS directly
below the axilla.
3. Note the sound produced from that strike.
4. Percuss approximately 5cm below the original location, or about every
other ICS.
5. Percuss down to the base of the lung.
Normal lung tissue produces a resonant sound. The diaphragm and the cardiac
N
silhouette emit dull sounds. Rib sounds are at. Hyperresonance is normal in
thin adults and in consumers with decreased musculature.
The presence of hyperresonance in the majority of adults is abnormal.
A
Hyperresonance is percussed in air-lled spaces. It can be elicited in
P
pneumothorax, emphysema, asthma and an emphysematous bulla.
The healthy human lung never produces a dull sound.
A
Dullness is found in solid or uid-lled structures. Pneumonia, atelectasis,
P
pulmonary oedema, pleural effusion, pulmonary brosis, haemothorax,
empyema and tumours are dull to percussion.
CHAPTER 13
Diaphragmatic excursion
Diaphragmatic excursion provides information on the consumer’s depth of
ventilation. This is accomplished by measuring the distance the diaphragm moves
during inspiration and expiration.
To perform diaphragmatic excursion:
E
1. Position the consumer for posterior thoracic percussion.
2. With the consumer breathing normally, percuss the right lung from the apex
(resonance in healthy adults) to below the diaphragm (dull). Note the level
at which the percussion note changes quality to orient your assessment to
the consumer’s percussion sounds. If full posterior thoracic percussion has
already been performed, then this step can be eliminated.
3. Instruct the consumer to inhale as deeply as possible and hold that breath.
4. With the consumer holding their breath, percuss the right lung in the
scapular line from below the scapula to the location where resonance
changes to dullness.
5. Mark this location and tell the consumer to exhale and breathe normally.
6. When the consumer has recovered, instruct the consumer to inhale as deeply
as possible, exhale fully, and hold this exhaled breath.
7. Repercuss the right lung below the scapula in the scapular line in a caudal
direction. Mark the spot where resonance changes to dullness.
8. Measure the distance between the two marks.
9. Repeat steps 1–8 for the left posterior thorax. Figure 13.20 illustrates
diaphragmatic excursion.
FIGURE 13.20 Diaphragmatic excursion
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
458 PHYSICAL EXAMINATION
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UNIT 2
The measured distance for diaphragmatic excursion is normally 3 to 5cm. The
N
level of the diaphragm on inspiration is T12, and T10 on expiration. The right
side of the diaphragm is usually slightly higher than the left.
A diaphragmatic excursion that is less than 3cm is abnormal.
A
Conditions involving hypoventilation, in which the consumer is unable to inhale
P
deeply or hold that breath, can lead to a reduction in the diaphragmatic excursion.
Pain, obesity, lung congestion, emphysema, asthma and pleurisy are examples.
A high diaphragm level suggests lung pathology.
A
Surgical intervention can elevate the diaphragm. If a lower lobe lobectomy is
P
performed, the diaphragm will move upwards to partially ll the empty space.
Likewise, after a pneumonectomy the paralysed diaphragm will move upwards,
leading to a high diaphragm level.
Space-occupying states such as
P
ascites and pregnancy will lead to an elevated
diaphragm due to the upwards displacement of the lungs and diaphragm.
If atelectasis or a pleural effusion is present in a lower lobe, then the diaphragm
P
will seem abnormally high, because these conditions are dull to percussion, as is
the diaphragm. The border between the diaphragm and the dull lung will thus
be indistinguishable.
REFLECTION IN PRACTICE
Diaphragmatic excursion technique
You are performing diaphragmatic excursion on a consumer. Midway through performing
this assessment, the consumer states, ‘Are you sure you know what you are doing? You
keep tapping me and I keep breathing over and over.’
> How would you respond to the consumer?
> Would you alter your assessment in any way after this comment?
> Why would you do so?
Auscultation
The aim of respiratory auscultation is to identify the presence of normal breath
sounds, abnormal lung sounds, adventitious (or added) lung sounds, and adventitious
pleural sounds. The anterior, posterior and lateral aspects of the chest are auscultated.
A stethoscope is required for this assessment. If an acoustic stethoscope is used,
the diaphragm, which transmits high-pitched sounds, is the headpiece of choice.
Technological developments accelerated because of the COVID-19 pandemic,
meaning that wireless stethoscopes (Zhang et al., 2021), articial intelligence
(Glangetas et al., 2021), and smartphone applications (Alkhodari & Khandoker, 2022)
are being used as safe and effective tools to support respiratory diagnoses.
CLINICAL REASONING
Practice tip: Factors affecting auscultation
When auscultating you need to consider factors that may impact on the quality of your
assessment. The following factors may impact on auscultation.
> Chest hair: Coarse or dense chest hair can be dampened to prevent the distortion of
auscultatory ndings (can sound like crackling).
> Rustling of paper gowns or drapes: Instruct the consumer to remain still while you are
auscultating the lungs.
> Mechanical ventilator tubing: Water accumulation in mechanical ventilator tubing can
produce a gurgling sound. Clear all tubing of moisture prior to auscultation.
> Shivering or chattering teeth: Ascertain why the consumer is shivering or chattering the
teeth (e.g. hypothermia) and intervene to correct the aetiology.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
RESPIRATORY 459
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General auscultation
Watch the consumer closely for signs of hyperventilation, such as dizziness. If the
consumer complains of dizziness, normal breathing should be resumed. Continue
the examination when their dizziness has gone and the consumer’s breathing has
returned to baseline.
To perform anterior thoracic auscultation:
E
1. Place the consumer in an upright sitting position with the shoulders back.
2. Instruct the consumer to breathe only through the mouth. Mouth breathing,
when compared to nasal breathing, decreases air turbulence, which can interfere
with the interpretation of breath sounds. Have the consumer inhale and exhale
deeply and slowly every time the stethoscope is felt or when instructed to do so.
3. Place the stethoscope on the apex of the right lung and listen for one
complete respiratory cycle (one inhalation and one exhalation).
4. Note the sound that is auscultated.
5. Repeat on the left apex.
6. Note the breath sound auscultated in each area and compare one side to the other.
7. Continue to move the stethoscope down approximately 5cm, or every
second ICS, comparing contralateral sides. Remember to visualise the
anatomic topography of the chest during auscultation (
To perform posterior thoracic auscultation:
Figure 13.18A).
CHAPTER 13
E
1. Place the consumer in an upright sitting position with a slight forwards tilt,
head bent down, and arms folded in front at the waist, as shown in
Figure 13.19. These actions move the scapulae laterally and maximise the lung
area that can be auscultated.
2. Place the stethoscope rmly on the consumer’s right lung apex. Ask the
consumer to inhale and exhale deeply and slowly every time the stethoscope
is felt on the back.
3. Repeat this process on the left lung apex.
4. Move the stethoscope down approximately 5cm, or every second ICS, and
auscultate in that area.
5. Auscultate in the same position on the contralateral side.
6. Continue to move inferiorly with the auscultation until the entire posterior
lung has been assessed. See
Figure 13.18B from the percussion section for the
recommended stethoscope location for each auscultation site.
To perform lateral thoracic auscultation:
E
1. Place the consumer in an upright sitting position with the hands and arms
directly overhead.
2. Auscultate the entire right thorax rst, then the entire left thorax, or
auscultate the right and left lateral thoraxes by comparing side to side. The
stethoscope should initially be placed in the ICS directly below the axilla.
3. Instruct the consumer to breathe only through the mouth. Have the
consumer inhale and exhale deeply and slowly every time the stethoscope is
felt on the lateral thorax.
4. Note the sound that is auscultated and continue to move the stethoscope
inferiorly approximately every 5 cm, or every second ICS, until the entire
thorax has been auscultated (
Figures 13.18C and 13.18D).
Breath sounds
Air rushing through the respiratory tract during inspiration and expiration
N
generates different breath sounds in the normal consumer. There are three
distinct types of normal breath sounds (see Table 13.2):
1. Bronchial (or tubular breath sound)
2. Bronchovesicular
3. Vesicular
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
460 PHYSICAL EXAMINATION
A. Anterior thorax B. Posterior thorax
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TABLE 13.2 Characteristics of normal breath sounds
RELATIVE DURATION OF INSPIRATORY
BREATH SOUND PITCH INTENSITY QUALITY
UNIT 2
Bronchial High Loud Blowing or hollow I < E Trachea
(I) AND EXPIRATORY (E) PHASES LOCATION
Bronchovesicular Moderate Moderate Combination of
bronchial and vesicular
Vesicular Low Soft Gentle rustling or
breezy
Each breath sound is unique in its pitch, intensity, quality, relative duration in the
inspiratory and expiratory phases of respiration, and location.
information. It is abnormal to auscultate these breath sounds in locations other
than where they are usually found. For example, a consumer with emphysema
may have
bronchial breath sounds in the peripheral lung parenchyma, where
vesicular sounds are expected to be found. Also keep in mind that heart sounds may
obscure some of the breath sounds during the anterior chest auscultation.
I = E Between scapulae, rst and
second ICS lateral to the sternum
I > E Peripheral lung elds
Table 13.2 depicts this
Vesicular
Bronchovesicular
Bronchial
FIGURE 13.21 Location of breath sounds
Breath sounds that are not normal can be classied as either abnormal or
adventitious breath sounds. Abnormal breath sounds are characterised by decreased
or absent breath sounds. Adventitious breath sounds are superimposed sounds
on the normal bronchial, bronchovesicular and vesicular breath sounds.
There are ve adventitious breath sounds:
1. Fine crackle
2. Coarse crackle
3. Wheeze
4. Pleural friction rub
5. Stridor
Table 13.3 depicts general characteristics of adventitious breath sounds.
Decreased breath sounds are abnormal.
A
Decreased breath sounds may be noted when auscultating a large chest because
P
of the distance between the lungs, where the sounds are generated, and the
chest wall.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
RESPIRATORY 461
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https://t.me/medicina_free
TABLE 13.3 Characteristics of adventitious breath sounds
BREATH
SOUND
RESPIRATORY
PHASE TIMING DESCRIPTION
Fine crackle Predominantly
inspiration
Coarse crackle Predominantly
inspiration
Wheeze Predominantly
expiration
Pleural friction
rub
Inspiration and
expiration
Stridor Predominantly
inspiration
CLEAR WITH
COUGH AETIOLOGY CONDITIONS
Discontinuous Dry, high-pitched crackling,
popping, short duration (roll
hair near ears between your
ngers to simulate this sound)
Discontinuous Moist, low-pitched crackling,
gurgling; long duration
No Air passing through
moisture in small
airways that
suddenly reinate
Possibly Air passing through
moisture in large
airways that
suddenly reinate
Continuous High pitched; musical Possibly Narrowing of
large airways or
obstruction of
bronchus
Continuous Creaking, grating No Inamed parietal
and visceral pleura;
can occasionally be
felt on thoracic wall
as two pieces of
dry leather rubbing
against each other
Continuous Crowing No Partial obstruction of
the larynx, trachea
COPD, heart
failure, pneumonia,
pulmonary brosis,
atelectasis
Pneumonia,
pulmonary oedema,
bronchitis, atelectasis
Asthma, chronic
bronchitis,
emphysema,
tumour, foreign
body obstruction
Pleurisy, tuberculosis,
pulmonary infarction,
pneumonia, lung
abscess
Croup, foreign body
obstruction, large
airway tumour
CHAPTER 13
CLINICAL REASONING
Practice tip: Upper airway sounds
If the consumer has secretions in the oropharynx (upper airway), whether from allergies,
infection, coryza or some other cause, their respirations may be loud and gurgling. It may
sound as if the consumer is having difculty breathing. Ask the individual to clear the throat,
then reassess the breath sounds.
An emphysematous consumer may have decreased breath sounds due to the
P
inability to inhale and exhale deeply.
Conditions such as bronchial obstruction and atelectasis may lead to decreased
P
breath sounds because a foreign object or sputum occludes some portion of the
respiratory tract, thus blocking the passage of air.
A
Absent breath sounds are always a pathological nding.
A pleural effusion, tumour, pulmonary brosis, emphysema, haemothorax and
P
hydrothorax lead to absent breath sounds. These states occupy or displace
normal aerating lung space internally or externally to the lungs.
A consumer with a large pneumothorax can present with absent breath sounds
P
due to the collapse of the lung.
Absent breath sounds occur when the lung has been removed
P
(pneumonectomy).
Blocked passageways in the respiratory tract explain the aetiology for absent
P
breath sounds in pulmonary oedema, massive atelectasis and complete
airway obstruction.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
Advanced Assessment
462 PHYSICAL EXAMINATION
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UNIT 2
CLINICAL REASONING
Lung auscultation practice
In addition to practising auscultation in the clinical setting, it is possible to rene skills on
the internet. Websites such as the R.A.L.E. Repository at http://www.rale.ca and the UCLA
Auscultation Assistant at http://www.wilkes.med.ucla.edu/ allow you to hear a variety of
normal and pathological breath sounds.
Voice sounds
The assessment of voice sounds is an additional assessment not commonly
practised by Australian and New Zealand Registered Nurses. Voice sounds assist
to conrm or distinguish potential abnormalities. They reveal whether the lungs
are lled with air, uid, or are solid. This auscultation is performed only if an
abnormality is detected during the general auscultation, percussion or palpation
assessment. There are three techniques by which voice sounds can be assessed:
1. Bronchophony
2. Egophony
3. Whispered pectoriloquy
Only one of these assessments needs to be performed because they all are
variations of the same physical principle and assessment technique, and they all
provide the same information. The voice sound ndings will parallel those obtained
during tactile fremitus. Thus, voice sounds will be heard loudest over the trachea
and softest in the lung’s periphery.
To perform bronchophony:
E
1. Position the consumer for posterior, lateral or anterior chest auscultation. The
area to be auscultated will be that in which an abnormality was found during
percussion or palpation or in which adventitious breath sounds were heard.
2. Place the stethoscope in the appropriate location on the consumer’s chest.
3. Instruct the consumer to say the words ‘99’ or ‘1, 2, 3’ every time the
stethoscope is placed on the chest or when told to do so.
4. Auscultate the transmission of the consumer’s spoken word.
To perform
E
1. Repeat steps 1 and 2 from the bronchophony procedure.
2. Instruct the consumer to say the sound ‘ee’ every time the stethoscope is
placed on the chest or when told to do so.
3. Auscultate the transmission of the consumer’s spoken word.
To perform whispered pectoriloquy:
E
1. Repeat steps 1 and 2 from the bronchophony procedure.
2. Instruct the consumer to whisper the words ‘99’ or ‘1, 2, 3’ every time the
stethoscope is placed on the chest or when told to do so.
3. Auscultate the transmission of the consumer’s spoken word.
The normal nding when performing tests for bronchophony, egophony and
N
whispered pectoriloquy is an unclear transmission or mufed sounds.
A
>
Positive (or present) voice sounds are:
• Bronchophony: clear transmission of ‘99’ or ‘1, 2, 3’ with increased intensity
• Egophony: transformation of ‘ee’ to ‘ay’ with increased intensity; the voice
• Whispered pectoriloquy: clear transmission of ‘99’ or ‘1, 2, 3’ with
Any type of consolidation process, such as pneumonia, will produce positive
P
voice sounds. Remember the principle that sound is transmitted reasonably well
by a uid medium.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
egophony:
has a nasal or bleating quality
increased intensity.
Advanced Assessment
RESPIRATORY 463
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Voice sounds are absent or even more decreased than in the normal lung in
A
conditions where the lung is more air-lled than usual.
Air conducts sound poorly. Therefore, air-lled lungs (emphysema, asthma,
P
pneumothorax) will produce absent voice sounds.
Table 13.4 compares physical examination ndings for 12 respiratory
conditions.
TABLE 13.4 Comparison of physical examination ndings in selected respiratory conditions
Figure 13.22 illustrates each of these 12 respiratory conditions.
INSPECTION
CONDITION SHAPE OF THORAX SKIN COLOUR: LIPS AND NAILS CLUBBING, ANGLE OF RIBS
CHAPTER 13
A. Normal lung 1:2 to 5:7 Pink in light-skinned individuals; darker
No clubbing, rib angle 45°
than normal in dark-skinned individuals
B. Asthma If chronic, may have barrel chest Pale or cyanotic in acute attack No clubbing, rib angle 45°
Atelectasis (patent bronchus) 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
C.
D.
Atelectasis (obstructed bronchus) 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
E. Bronchiectasis 1:1 (barrel chest) Pale or cyanotic if severe Clubbing possible, rib angle >45°
F. Bronchitis 1:2 to 5:7 Possibly pale No clubbing, rib angle 45°
G. Chronic heart failure 1:2 to 5:7 Pale or cyanotic Clubbing possible, rib angle 45°
H.
Emphysema 1:1 (barrel chest) Pale Clubbing, rib angle >45°
I. Pleural effusion 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
J. Pneumonia with lobar consolidation 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
K. Pneumothorax 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
L.
Pulmonary oedema 1:2 to 5:7 Pale or cyanotic No clubbing, rib angle 45°
INSPECTION
CONDITION CAPILLARY REFILL RETRACTIONS OR BULGING OF ICS RESPIRATORY RATE
Normal lung Brisk Absent 12–20/min eupnoea
A.
B.
Asthma Sluggish in acute attack Retractions 20/min tachypnoea
C. Atelectasis (patent bronchus) Sluggish to moderate Absent >20/min tachypnoea
D. Atelectasis (obstructed bronchus) Sluggish Absent >20/min tachypnoea
E. Bronchiectasis Sluggish if severe Retractions if severe >20/min tachypnoea
F. Bronchitis Sluggish to moderate Absent >20/min tachypnoea
G. Chronic heart failure Sluggish Retractions >20/min tachypnoea
H. Emphysema Sluggish Both present >20/min tachypnoea
I. Pleural effusion Sluggish Bulging >20/min tachypnoea
J. Pneumonia with lobar consolidation Sluggish Absent >20/min tachypnoea
K. Pneumothorax Sluggish Bulging >20/min tachypnoea
L. Pulmonary oedema Sluggish Absent >20/min tachypnoea
PALPATION
CONDITION THORACIC EXPANSION TACTILE FREMITUS TRACHEAL POSITION
A. Normal lung 3–5cm Moderate (normal) Midline
B. Asthma Decreased in attack Decreased Midline
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
>>
Advanced Assessment
464 PHYSICAL EXAMINATION
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TABLE 13.4 continued>>
CONDITION THORACIC EXPANSION TACTILE FREMITUS TRACHEAL POSITION
C. Atelectasis (patent bronchus) Decreased Increased Shifts to affected side
UNIT 2
D. Atelectasis (obstructed bronchus) Decreased Increased Shifts to affected side
E. Bronchiectasis Decreased on affected side Increased Midline or deviated toward
F. Bronchitis Possibly decreased Moderate or increased Midline
G. Chronic heart failure May be decreased Moderate Midline
H. Emphysema Decreased Decreased Midline
I. Pleural effusion Decreased Decreased Shifts to unaffected side
J. Pneumonia with lobar consolidation Decreased Increased Shifts to affected side
K. Pneumothorax Decreased Absent or decreased Shifts to unaffected side
L. Pulmonary oedema Decreased Increased Midline
CONDITION GENERAL PERCUSSION DIAPHRAGMATIC
A. Normal lung Resonant 3–5 cm
B. Asthma Hyperresonant Decreased
C. Atelectasis (patent bronchus) Dull Decreased
D. Atelectasis (obstructed bronchus) Dull Decreased
E. Bronchiectasis Resonant to dull Decreased
F. Bronchitis Resonant Decreased if severe
G. Chronic heart failure Resonant Decreased
H. Emphysema Hyperresonant Decreased
I. Pleural effusion Dull Decreased
J. Pneumonia with lobar consolidation Dull Decreased
K. Pneumothorax Hyperresonant Decreased
L. Pulmonary oedema Dull Decreased
CONDITION BREATH SOUNDS ADVENTITIOUS SOUNDS VOICE SOUNDS
A. Normal lung Vesicular in periphery Absent Mufed
B. Asthma Decreased or absent in severe
C. Atelectasis (patent bronchus) Bronchial Crackles or wheezes Increased or mufed
D. Atelectasis (obstructed bronchus) Absent or decreased Absent Absent or mufed
E. Bronchiectasis Vesicular or bronchial if severe Crackles or wheezes Mufed or decreased
F. Bronchitis Vesicular or bronchial Crackles or wheezes Increased or mufed
G. Chronic heart failure Vesicular Crackles Mufed
H. Emphysema Bronchial and decreased Wheezes Decreased
I. Pleural effusion Absent or decreased Possible friction rub Decreased or absent
J. Pneumonia with lobar consolidation Bronchial Crackles or occasional friction rub Increased
K. Pneumothorax Absent or decreased Absent Decreased or absent
L. Pulmonary oedema Absent or decreased Crackles Increased
PALPATION
affected side
PERCUSSION
EXCURSION
AUSCULTATION
Wheezes Decreased
obstruction
RESPIRATORY 465
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Left lung: depicts healthy lung
Right lung: depicts pathology
A. Normal lung B. Asthma
Shape of thorax: 1:2 to 5:7
Tracheal position: midline
Percussion: resonant
Adventitious sounds: absent
D. Atelectasis
(obstructed bronchus)
Shape of thorax: 1:2 to 5:7
Tracheal position: shifts to affected side
Percussion: dull
Adventitious sounds: absent
Obstruction
Engorged
pulmonary
capillaries
Dependent
airways
deated
Bronchial oedema with
increased production of thick mucus
Collapsed
portion
of lung
Shape of thorax: 1:2 to 5:7 unless
chronic may have barrel chest
Tracheal position: midline
Percussion: hyperresonant
Adventitious sounds: wheezes
Dilated
bronchi
Shape of thorax: 1:2 to 5:7
Tracheal position: shifts to affected side
Percussion: dull
Adventitious sounds: crackles or wheezes
Bronchial inammation
and constriction
E. Bronchiectasis F. Bronchitis
Shape of thorax: 1:1
Tracheal position: midline or
deviated toward affected side
Percussion: resonant to dull
Adventitious sounds: crackles
or wheezes
Shape of thorax: 1:2 to 5:7
Tracheal position: midline
Percussion: resonant
Adventitious sounds: crackles or
wheezes
Pleural
effusion
and
thickening
CHAPTER 13
C. Atelectasis
(patent bronchus)
G. Chronic
heart failure
Shape of thorax: 1:2 to 5:7
Tracheal position: midline
Percussion: resonant
Adventitious sounds: crackles
Consolidation
J. Pneumonia
with lobar consolidation
Shape of thorax: 1:2 to 5:7
Tracheal position: shifts to affected side
Percussion: dull
Adventitious sounds: crackles or
occasional friction rub
FIGURE 13.22 Comparison of selected respiratory conditions
Fluid in
pleural
space
Hyperinated alveoli
H. Emphysema I. Pleural effusion
Shape of thorax: 1:1
Tracheal position: midline
Percussion: hyperresonant
Adventitious sounds: wheezes
Air in
the pleural
space
K. Pneumothorax
Shape of thorax: 1:2 to 5:7
Tracheal position: shifts to
unaffected side
Percussion: hyperresonant
Adventitious sounds: absent
Shape of thorax: 1:2 to 5:7
Tracheal position: shifts to unaffected side
Percussion: dull
Adventitious sounds: possible friction rub
L. Pulmonary oedema
Shape of thorax: 1:2 to 5:7
Tracheal position: midline
Percussion: dull
Adventitious sounds: crackles
Extravascular
accumulation
of uid in the
pulmonary
tissues and
air spaces
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