1.1. PhysicalPhysical examinationexamination of of

thethe chestchest

2. 2. PhysicalPhysical signssigns of of

pulmonarypulmonary syndromessyndromes

Dr. Zsuzsa Dr. Zsuzsa NebenfNebenfüührerhrer 20122012

HistoryHistory

�� SymptomsSymptoms ((painpain, , dyspneadyspnea, , coughcough))

�� FeverFever

�� OccupationOccupation, , jobjob

�� MedicationMedication

PhysicalPhysical examinationexamination

�� InspectionInspection

�� PalpationPalpation

�� PercussionPercussion

�� AuscultationAuscultation

LinesLines onon thethe chestchest

InspectionInspection

CyanosisCyanosis

ClubbingClubbing

InspectionInspection

ChestChest

�� ShapeShape of of thethe chestchest

�� ChestChest expansionexpansion

CausesCauses of of chestchest deformitydeformity

�� DiseasesDiseases of of thethe vertebralvertebral coloumncoloumn

�� kyphosiskyphosis, , lordosislordosis, , scoliosisscoliosis

�� kyphoscoliosiskyphoscoliosis

�� NeurologicalNeurological disordersdisorders: : �� palsypalsy of of thethe m. m. serratusserratus →→ scapulascapula aleataaleata

�� ssyringomyeliayringomyelia

�� DiseasesDiseases of of thethe lunglung oror thethe pleurapleura: : �� air air oror fluid fluid inin thethe pleuralpleural cavitycavity

�� shrinkigshrinkig of of thethe ppleuraleura oror atelectasiatelectasiss

InspectionInspection

�� ShapeShape of of thethe chestchest

�� symmetricsymmetric

�� barrel barrel chestchest

�� pigeonpigeon chestchest

�� pectuspectus excavatumexcavatum

�� ChestChest expansionexpansion

ChestChest expansionexpansion decreaseddecreased

�� SymmetricalSymmetrical onon

bothboth sidessides: :

•• severesevere airwayairway

obstructionobstruction

•• pulmonarypulmonary fibrosisfibrosis

•• BechterewBechterew diseasedisease

�� UnilateralUnilateral: :

•• pleuralpleural effusioneffusion

•• ptxptx

•• pneumoniapneumonia

•• calluscallus

•• tbc tbc

PalpationPalpation of of thethe tracheatrachea

�� Normal: Normal: midlinemidline

�� DislocationDislocation: :

�� MassMass inin thethe neckneck ((goitergoiter) )

�� DislocationDislocation of of thethe mediastinummediastinum

�� TowardToward thethe healthyhealthy sideside

�� PtxPtx

�� LargeLarge pleuralpleural effusioneffusion

�� TowardToward thethe sideside of of thethe diseasedisease

�� CollapseCollapse of of thethe lunglung duedue toto centralcentral airwayairway obstructionobstruction

�� Local Local fibrosisfibrosis

PalpationPalpation

�� ChestChest excursionexcursion

�� PleuralPleural rubrub: : palpablepalpable, , audibleaudible ––

pleuritispleuritis

�� Tender Tender areasareas

�� pleuritispleuritis

�� ribrib: : fracturefracture, , periostitisperiostitis, , metastasismetastasis

�� sternumsternum: : anaemiaanaemia, , leukaemialeukaemia, , myelomamyeloma

�� TactileTactile fremitusfremitus

TactileTactile fremitusfremitus

�� Normal: Normal: symmetricsymmetric

�� DecreasedDecreased::

�� ObstructionObstruction of of thethe

airwaysairways

�� Fluid, air, Fluid, air, calluscallus inin

thethe pleurapleura

�� IncreasedIncreased: :

�� PneumoniaPneumonia, tumor, tumor

PercussionPercussion

�� TopographicTopographic

�� ComparativeComparative

BordersBorders of of thethe lunglung

�� ParavertebralParavertebral and and scapularscapular line: XI. line: XI. thoracicthoracic

vertebravertebra

�� MidaxilllaryMidaxilllary: VIII. : VIII. ribrib

�� Right Right midclavicularmidclavicular line: VI. line: VI. ribrib

�� LeftLeft midclavicularmidclavicular line : IV. line : IV. ribrib ((dullnessdullness of of thethe

heartheart))

PercussionPercussion

DislocationDislocation of of lunglung bordersborders

�� DeeperDeeper onon bothboth sidessides: : �� emphysemaemphysema

�� acuteacute bronchialbronchial asthmaasthma

�� congenitalcongenital

�� ((DeeperDeeper onon oneone sideside: : ptxptx))

�� HigherHigher onon bothboth sidessides: : �� increasedincreased abdominalabdominal pressurepressure

�� ((pleuralpleural fluid fluid onon bothboth sidessides))

�� HigherHigher onon oneone sideside::�� n. n. phrenicusphrenicus palsypalsy

�� shrinkingshrinking lunglung oror pleuralpleural diseasedisease

�� oneone sidedsided abdominalabdominal diseasedisease

�� ((pleuralpleural fluid)fluid)

�� right right lunglung bit bit higherhigher physiologicallyphysiologically

PercussionPercussion

�� TraubeTraube

�� KrKröönignig

PercussionPercussion

�� TraubeTraube

�� KrKröönignig

PercussionPercussion

�� Normal: Normal: resonanceresonance

ComparativeComparative percussionpercussion�� DullnessDullness

�� No No airair--filledfilled lunglung tissuetissue�� infiltrationinfiltration inin thethe alveolialveoli: : pneumoniapneumonia, tumor, tbc, tumor, tbc

�� no air no air inin thethe alveolialveoli = = atelectasiaatelectasia

�� SomethingSomething inin thethe pleuralpleural cavitycavity�� exsudationexsudation, , tanssudationtanssudation, , puspus = = empyemaempyema, , bloodblood = = haemothoraxhaemothorax

�� tumor, tumor, calluscallus

�� TympanicTympanic�� ptxptx

�� bigbig cavernacaverna

�� relaxationrelaxation of of lunglung tissuetissue

�� over over thethe lowerlower part of part of leftleft lunglung (+ air (+ air inin thethestomachstomach))

�� HyperresonanceHyperresonance�� emphysemaemphysema

AuscultationAuscultation

�� VesicularVesicular

�� BronchivesicularBronchivesicular

�� BronchialBronchial

�� TrachealTracheal

AdventitiousAdventitious soundsound

�� BronchialBronchial (air (air atat inin-- exspirationexspiration + +

mucus) mucus)

�� DryDry: : wheezeswheezes

�� WetWet: : cracklescrackles

�� StertorStertor

�� PleuralPleural

�� RubRub

TransmittedTransmitted voicevoice soundssounds

�� BronchophonyBronchophony

�� 9999

�� 6666