What do you hear on auscultation with pleural effusion?
Though taught extensively in early medical training the pulmonary exam is often neglected apart from auscultation. Show
The "5-7-9 rule"
Cardiac dullnessBe able to outline the area of "absolute" cardiac dullness— a fist sized area just to the left of the sternum. If it is not there it suggests emphysema. Traube's space
Click here to read an article on the Ludwig Traube. Tidal Percussion
Historical Perspective of the Pulmonary ExamPercussion was first described by Dr. Josef Leopold Auenbrugger, an Austrian physician who first observed his father tapping on wine barrels in the cellar of his hotel to determine how much wine was left. The son applied this technique to patients when he became a physician. He is credited with bringing the technique of percussion to the field of medicine. Much of his work occurred around 1760 where he described that by percussing the thorax he could accurately predict the contents of what was inside, as confirmed with post-mortum studies he conducted. Signs of COPD
REMEMBER : "The side that moves less, is the side of disease!" Look for signs of volume loss (or gain) on the side that moves less(hollow supraclavicular fossae, intercostal spaces prominent, shoulder droopy, scapula outline more prominent). Dr. Peadar NooneDr. Peadar Noone trained in Galway, Dublin, Boston, the UK and Chapel Hill, where he is now Associate Professor of Medicine and Medical Director of the Lung Transplant Program at the University of North Carolina, Chapel Hill. Clinical PearlInsert (in a normal individual) three fingers vertically in the space under the cricoid cartilage, and above the sternal notch. As the person breathes in, the space may reduce to two fingers at most (i.e. the fingers get "squeezed" as the sternum rises with inspiration). In a patient with severe hyperinflation, the crico-sternal distance is much shorter (because the sternum is elevated), maybe 1-2 fingers at most. With inspiration one's fingers get "squeezed" out as the already "high" sternum rises up to the level of the cricoid, thus, in many cases, obliterating the crico-sternal distance altogether. Some clinicians label this sign "tracheal shortening" but strictly speaking, the actual tracheal length does not get shorter. Classically this is seen with severe emphysema / hyperinflation, or severe air trapping. Often accompanied by reduced hepatic and cardiac dullness on percussion, a widened / flared costal angle, and Hoover's sign. Other Findings in the Chest
What would you hear on auscultation with pleural effusion?Auscultation over a pleural effusion will produce a very muffled sound. If, however, you listen carefully to the region on top of the effusion, you may hear sounds suggestive of consolidation, originating from lung which is compressed by the fluid pushing up from below.
Can you hear pleural effusion with a stethoscope?Using a stethoscope, the health care provider may hear normal breathing sounds, decreased or absent breath sounds, and abnormal breath sounds. Absent or decreased sounds can mean: Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion)
How do you hear a pleural effusion?Symptoms of a pleural effusion can include shortness of breath, chest pain and cough. The physician will listen to the chest with a stethoscope for signs of decreased breath sounds or a pleural friction rub—the sound of pleura rubbing together during respiration.
Can pleural effusion be Auscultated?Assessing the Likelihood of Pleural Effusion
The physician should perform palpation, percussion, and auscultation of the chest when pleural effusion is considered. Dullness to conventional percussion and reduced tactile fremitus are the best findings for identifying patients with pleural effusion (Table 71-1).
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