percussion tests for pleural effusion.pptx

pleural effusion
percussion test for pleural effusion
Examination by AP is highly sensitive and specific for the detection of free pleural fluid, even in the presence of obesity, thickened pleura, lung masses, pneumonia, and associated lung disease. The examination correlates closely with standard and lateral decubitus chest radiography. Pleural effusion unsuspected by conventional means of physical examination and undetectable by standard chest radiography can readily be detected by the method of AP. The examination is easy to do and is particularly suited to enhance detection of pleural effusion. As little as 50 mL of free pleural fluid can be detected.
118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for evidence of pleural effusion. The cutoff in the percussion note by AP is strikingly loud and sharp at the fluid level and allows precise delineation of even minimal amounts of pleural fluid. The fluid level was measured in reference to the last rib. The criterion for detection of pleural effusion by AP was a demonstrable horizontal fluid level at the sound cutoff across the posterior hemithorax above the last rib that shifted with lateral tilt.
Based on the limited number of studies, dullness to percussion and tactile fremitus are the most useful findings for pleural effusion. Dull chest percussion makes the probability of a pleural effusion much more likely but requires a chest radiograph to confirm the diagnosis. When the pretest probability of pleural effusion is low, the absence of reduced tactile vocal fremitus makes pleural effusion less likely so that a chest radiograph might not be necessary depending on the overall clinical situation.

1. Percussion in pleural effusion PRESENTER DR AASHISH MODERATOR DR ALAKA

2. Collection of fluid within the pleural cavity (in between visceral and parietal layers of pleura) is pleural effusion .

3. Percussion in pleural effusion The percussion note is dull as there is underlying fluid in pleural effusion. Pleural effusion causes the sensation in the percussed finger to be similar to that felt when a solid wall is percussed. This is often called ‘stony dullness’. By comparing side with side, it is usually easy to detect unilateral pleural effusion.

4. Grocco’s triangle Area of dullness (triangular) on percussion against the vertebral column at the base of opposite lung ( Grocco’s triangle)—as a result of fluid forming a mediastinal bulge. Base - Horizontally along 12 th rib Apex - At the level Of upper margin of Fluid on diseased side Internally - Vertebral line Externally - Line joining the apex and lateral base

5. Left sided pleural effusion In ‘left’- sided pleural effusion, the dullness is continuous with cardiac dullness with loss of Traube’s space tympanicity .

6. Right sided pleural effusion The stony dullness of ‘right’-sided pleural effusion is continuous with liver dullness Massive pleural effusion In massive pleural effusion, the dullness (on percussion) extends upto the 2 nd ICS or above.

7. Pleural effusion Hydropneumothorax Percussion above fluid level is resonant Percussion note above the fluid level—Tympanic Shifting dullness—Absent Shifting dullness—Present. Coin sound in upper chest—Absent. Coin sound in upper chest—May be present. Succussion splash—Absent. Succussion splash—Present. Classical horizontal fluid level—Present but difficult to demonstrate. Horizontal fluid level on percussion—Easily demonstrated.

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