|
Lesion |
Chest movements |
Percussion |
Vocal fremitusa |
Breath sounds |
Displacement of the mediastinumb |
|
Infiltrate |
Asymmetric, motion impaired on the side of infiltrate |
Dull |
Increased |
Bronchial breathing, crackles |
No |
|
Atelectasis |
Asymmetric, motion markedly impaired on the side of atelectasis (if large) |
Dull |
– Reduced (atelectasis caused by airway obstruction) – Increased (atelectasis caused by airway compression) |
– Reduced lung sounds – Occasional crackles – Bronchial breathing may be audible |
Towards the side of atelectasis in setting of lobar collapse |
|
Fibrosis (bilateral) |
Slightly impaired symmetrically |
Slightly dull |
Slightly reduced |
– Reduced lung sounds – Crackles |
No |
|
Pleural effusion |
Asymmetric, motion impaired on the side of effusion |
Dull |
Reduced |
Absent breath sounds; in the setting of small pleural effusions pleural friction rub may be audible |
Away from the side of effusion (if large) |
|
Pneumothorax |
Asymmetric, motion impaired on the side of pneumothorax |
Hyperresonant |
Absent |
Absent breath sounds |
With tension pneumothorax, away from the side of the lesion |
|
Airway obstruction |
– Symmetrically increased – Work of accessory respiratory muscles usually seen |
Usually normal |
Unchanged or reduced |
– Wheezes and rhonchi – Prolonged expiratory phase – Normal lung sounds, may be reduced with occasional crackles |
No |
|
a Transmission of spoken words while listening with a stethoscope (eg, “blue balloons,” “toy boat”). b Displacement of the trachea may sometimes be observed on physical examination of the neck. |
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