Physical examination maneuver

Physical Exam

Chest Percussion

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Video coming September 2026

How to Perform

Place the middle finger of your non-dominant hand flat against the chest wall in an intercostal space, and strike its distal interphalangeal joint sharply with the tip of your dominant middle finger using a quick wrist motion. Compare the note over symmetric points side to side, noting whether it is resonant, dull, or hyperresonant.

How to Interpret

Showing 3 of 14 findings

Large Pleural Effusion

Stony dullness
Rule in
Helpful
Rule out
—
Evidence:Strong

Lobar Pneumonia or Consolidation

Dullness to percussion
Rule in
Somewhat helpful
Rule out
—
Evidence:Strong

Pleural Effusion

Dullness to conventional percussion over the affected hemithorax
Rule in
Helpful
Rule out
—
Evidence:Strong

References

  • Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317. doi:10.1001/jama.2008.937. PubMed: 19155458.
  • Ebell MH, Chupp H, Cai X, Bentivegna M, Kearney M. Accuracy of Signs and Symptoms for the Diagnosis of Community-acquired Pneumonia: A Meta-analysis. Acad Emerg Med. 2020;27(7):541-553. PMID: 32329557.
  • Wong CL, Holroyd-Leduc J, Straus SE. Does This Patient Have a Pleural Effusion? JAMA. 2009;301(3):309-317. PMID 19155458.
  • Auenbrugger L. Inventum Novum ex Percussione Thoracis Humani ut Signo Abstrusos Interni Pectoris Morbos Detegendi. Vienna: Trattner; 1761.

Related Systems / Regions

RespiratoryThorax

Related Bedside Tests

🎬Video coming Sept 2026
Lung Auscultation
Rule in:VHPneumothorax, HMainstem Bronchus Intubation, HPleural Effusion +24 more
Rule out:VHPleural Effusion, SHMainstem Bronchus Intubation, SHPneumothorax +23 more
🎬Video coming Sept 2026
Tactile Fremitus
aka Vocal fremitus
Rule in:HPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more
Rule out:SHPleural Effusion, IEAtelectasis with Airway Obstruction, IECOPD with Hyperinflation +3 more
🎬Video coming Sept 2026
Oxygen Saturation
aka Pulse oximetry
Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more
Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more
🎬Video coming Sept 2026
Pulsus Paradoxus
aka Paradoxical pulse
Rule in:SHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more
Rule out:VHCardiac Tamponade, SHSevere Asthma Exacerbation, IECOPD Exacerbation +2 more
🎬Video coming Sept 2026
Point of Maximal Impulse
aka Apical impulse; apex beat
Rule in:VHLeft Ventricular Dilation, HLeft Ventricular Hypertrophy, SHCardiomegaly +7 more
Rule out:VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy, MHCardiomegaly +7 more
🎬Video coming Sept 2026
Bronchophony
Rule in:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation
Rule out:IEAtelectasis with Patent Airway, IELobar Pneumonia or Consolidation