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Chest examination

Chest examination can be performed by visual inspection, palpation, percussion, and auscultation. Each method has its own advantages. This picture introduces the common examination knowledge for each diagnosis and treatment method.

Edited at 2023-10-29 17:47:28

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Chest examination

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Outline

Chest examination

Inspection

thorax

normal

The anteroposterior and transverse diameters of adults are approximately 1:1.5

In children and the elderly, the anteroposterior diameter is slightly smaller than or equal to the transverse diameter.

abnormal

barrel chest

Seen during chronic obstructive emphysema and bronchial asthma attacks

flat chest

Seen in people with a lanky body type, or tuberculosis, etc.

Rickets chest

Chicken breast, common in children, seen in congenital heart disease

pectus excavatum

Seen in patients with rickets and mitral valve prolapse

One side or localized deformation

Thoracic distension

one side

Seen in large amounts of pleural effusion on one side, pneumothorax, etc.

limitation

Seen in cardiac hypertrophy, massive pericardial effusion, aortic aneurysm, etc.

Thoracic depression

Seen in atelectasis, pulmonary fibrosis, etc.

Caused by spinal deformity

chest wall

chest wall veins

No obvious veins are visible on the normal chest wall

When the superior and inferior vena cava return is blocked and collateral circulation is established, the chest wall veins may become filled or varicose.

intercostal space

retract

Airway obstruction. The "three concavities sign" is seen in stenosis or obstruction of the larynx, trachea, and large bronchi.

bulging

Seen in massive pleural effusion, tension pneumothorax or severe emphysema.

lungs and pleura

Breathing type

chest breathing

Normal adult female. It can be seen in abdominal diseases such as peritonitis and ascites and in late pregnancy.

abdominal breathing

Children and adult males. It can be seen in chest diseases such as pneumonia and severe tuberculosis.

Breathing rate depth and rhythm

Respiratory rate

Tachypnea (>20 times/min)

Seen in strenuous physical activity, fever, hyperthyroidism, etc.

Bradypnea (<12 breaths/min)

Seen in deep sleep, intracranial hypertension, barbiturate poisoning, etc.

Breathing depth

Breathe deeply and quickly

Kusmore's breathing, seen in uremia, diabetic ketoacidosis, etc.

Breathing shallowly and quickly

Seen in pneumonia, pleurisy, pneumothorax, etc.

breathing rhythm

tidal breathing

Chen-Shi breathing is seen in hypoxia or CO₂ retention.

pause in breathing

Biot's breathing is seen in intracranial hypertension caused by central nervous system diseases.

irregular breathing

Seen in severe central nervous system disease and shock.

Sobbing breathing

Seen in intracranial hypertension and pre-herniation lesions.

Sighing breathing

Seen in people with neurasthenia, nervousness or depression

respiratory movements

weaken or disappear

limitation

Seen in lobar pneumonia, tuberculosis, lung abscess, etc.

one side

Seen in large amounts of pleural effusion, pneumothorax, atelectasis of one lung, etc.

both sides

Seen in bilateral pulmonary fibrosis, pneumothorax, etc.

Enhance

palpation

chest wall

subcutaneous emphysema

Seen in lung trauma or disease, local infection with Aerobacillus aerogenes, etc.

chest wall tenderness

The chest compression test is an important sign in the diagnosis of traumatic rib fractures. It can also be seen in patients with leukemia who have abnormal bone marrow hyperplasia.

lungs and pleura

Thoracic expansion

Restricted expansion is seen in pleural effusion, pneumothorax, pleural thickening, and atelectasis.

tactile tremor

Enhance

Seen in pulmonary consolidation, large cavities in the lungs, lobar pneumonia, etc.

weaken

Seen in excessive air content in the alveoli, bronchial obstruction, pleural effusion, pneumatosis, etc.

Pleural friction sensation

It is most easily felt in the 5th to 7th intercostal spaces of the midaxillary line.

percussion

Percussion of lung boundary

upper boundary of lung

Voicing or narrowing of voiceless sounds: tuberculosis, pulmonary fibrosis

Clear or widen: emphysema, pneumothorax

anterior border of lung (absolute heart dullness area)

Narrow down: emphysema

Enlargement: cardiomegaly, pericardial effusion, pleurisy

lower boundary of lung

position

Midclavicular line-6, mid-axillary line-8, scapular line-10

move down

Seen in emphysema, abdominal visceroptosis, etc.

Move up

Seen in obstructive atelectasis, lung atrophy, pleural effusion, pneumothorax, etc.

mobility of lower lung boundary

Normal 6-8cm, weakened <4cm, will not increase

weaken

Loss of elasticity of lung tissue: emphysema Collapse of lung tissue: pulmonary fibrosis, atelectasis Local pleural adhesions: pleurisy, lung tissue inflammation after chest surgery, edema

Hard to knock out

Massive pleural effusion, pneumothorax, and extensive pleural hypertrophy

Normal chest percussion sounds

unvoiced

Normal lungs, back from the suprascapular area to the lower edge of the 9th-11th rib, except for the spine

voiced sound

The overlapping area where the lungs meet the liver or heart

solid sound

The heart or liver not covered by the lungs, also known as the absolute dullness area of the heart or liver

Drum sound

The lower left side of the chest is the gastric tympanic sound area.

Physiological variation

The percussion sound in the upper part of the chest is relatively dull compared to the lower part. The percussion sound in the upper part of the right lung is slightly duller than that in the upper part of the left lung. The percussion sound on the back is slightly duller than that on the front chest The right armpit is slightly turbid

Abnormal chest percussion sounds

Voiced or solid sound

Seen in pulmonary effusion, lung tumors, pleural effusion, etc.

drum sound

Seen in cavitary tuberculosis, liquefied and ruptured lung abscess or lung tumor, pneumothorax, etc.

Too unvoiced

Seen during emphysema and bronchial asthma attacks

empty urn sound

Seen in large cavities, superficial locations and smooth cavity walls, or tension pneumothorax, etc.

Broken pot sound

Seen in large cavities and pneumothorax in tuberculosis

Voiced tympanic sound

Seen in atelectasis, congestion or dissipation phase of pneumonia, pulmonary edema, etc.

auscultation

normal breath sounds

tracheal breath sounds

Rough, loud and high-pitched, does not indicate lung disease.

bronchial breath sounds

Location: larynx, suprasternal fossa, 6th and 7th cervical vertebrae, 1st and 2nd thoracic vertebrae

Features: "Ha——" sound, short inhalation and long exhalation

Alveolar breath sounds

Site: normal lung tissue

Characteristics: "Husband——" sound, long inhalation and short exhalation

bronchoalveolar breath sounds

Location: Near the sternal angle, 3rd and 4th thoracic vertebrae

Characteristics: Inhalation is alveolar, expiration is bronchial.

Pathological breath sounds

pathological alveolar breath sounds

weaken or disappear

Seen in respiratory movement disorders, respiratory obstruction, intrathoracic masses, pleural diseases, chest wall thickening, etc.

Enhance

Seen in exercise, fever, respiratory center excitement, hyperthyroidism, etc.

extend

Seen in bronchial asthma, wheezing bronchitis, chronic obstructive emphysema, etc.

intermittent breath sounds

Seen in pneumonia, tuberculosis, bronchial lung cancer, etc.

rough breath sounds

Seen in the early stages of bronchitis or pneumonia

Pitch-modified breath sounds

Seen due to movement of foreign bodies within relaxed bronchial tubes

Pathological bronchial breath sounds

Consolidation of lung tissue

Seen in the consolidation stage of lobar pneumonia, pulmonary tuberculosis, lung abscess, lung tumors, etc.

Large cavity in lung

Seen when tuberculosis, lung abscess, and lung cancer form cavities.

Compressive atelectasis

Seen above a moderate amount of pleural effusion, in the left subscapular area when there is a large amount of pericardial effusion, and around the lung mass

Pathological bronchoalveolar breath sounds

Pulmonary consolidation is small and the location of consolidation is deep

Seen in early stages of bronchopneumonia, tuberculosis, and lobar pneumonia

rales

Dry rales

Features: high adjustment, long duration, obvious exhalation, changeable position

Category: snoring sound - low tone, large airway Whistle tone - high pitch, small airway

Clinical significance: bilateral → asthma localization→tumor

rales

Characteristics: intermittent and short, obvious inhalation, constant location, unchangeable nature, can be relieved or disappeared after coughing

Classification

According to bronchial caliber: thick, medium and fine crackles

According to the loudness level: loud crackles and non-loud crackles

Clinical significance: unilateral → pneumonia Bilateral→pulmonary stasis

Crepitus

Seen in the elderly, those who sleep deeply or are bedridden for a long time; pneumonia or early stage of tuberculosis, pulmonary blood stasis, etc.

auditory speech

weaken

Seen in excessive weakness, bronchial obstruction, chronic obstructive emphysema, etc.

Enhance

Seen in pulmonary consolidation, pulmonary cavities, and compressive atelectasis

"The sound of sheep"

pleural friction rub

Location: Anterior and inferior chest wall

Cause: Major pleural inflammation makes the pleural surface rough

Clinical significance: seen in dry pleurisy, pulmonary infarction, uremia, etc.