Physical examination maneuver
Physical Exam
Chest Percussion
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Video coming soon
How to Perform
Place the middle finger of your nondominant 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. Percuss symmetric upper, middle, and lower posterior lung fields, comparing side to side at each level, and assess additional areas as clinically indicated. Note whether the percussion note is resonant, dull, or hyperresonant.
How to Interpret
Showing 5 of 19 findings
Cardiomegaly
Cardiac dullness by percussion beyond 10.5 cm from the midsternal line in the left fifth interspace (supine)
Rule in
Somewhat helpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate
Chronic Obstructive Pulmonary Disease
Hyperresonance to percussion in an adult with respiratory symptoms
Rule in
Helpful
Rule out
Not helpfulDerived CI
Evidence:Moderate
Left Ventricular Dilation
Cardiac dullness by percussion beyond 10.5 cm from the midsternal line in the left fifth interspace (supine), detecting increased left ventricular end-diastolic volume or mass
Rule in
Not helpfulDerived CI
Rule out
InconclusiveWide CI
Evidence:Moderate
Pleural Effusion
Dullness to conventional percussion over the affected hemithorax
Rule in
Helpful
Rule out
InconclusiveWide CI
Evidence:Strong
Pneumonia
Dullness to percussion
Rule in
Somewhat helpfulWide CI
Rule out
Not helpful
Evidence:Strong
Related Bedside Tests
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Lung Auscultation
Rule in:VHChronic Obstructive Pulmonary Disease, VHPneumothorax, HMainstem Bronchus Intubation +29 more
Rule out:VHChronic Obstructive Pulmonary Disease, HPleural Effusion, SHInterstitial Lung Disease +28 more
🎬Video coming soon
Tactile Fremitus
aka Vocal fremitus
Rule in:HPleural Effusion, IEAtelectasis, IEChronic Obstructive Pulmonary Disease +3 more
Rule out:SHPleural Effusion, IEAtelectasis, IEChronic Obstructive Pulmonary Disease +3 more
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Chest and Respiratory Inspection
Rule in:VHMitral Valve Prolapse, HPleural Effusion, HReduced Left Ventricular Ejection Fraction +11 more
Rule out:HRespiratory Neuromuscular Weakness, SHChronic Obstructive Pulmonary Disease, SHPleural Effusion +12 more
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Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
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Point of Maximal Impulse
aka Apical impulse; apex beat
Rule in:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHLeft Ventricular Dilation +14 more
Rule out:VHAortic Stenosis, VHLeft Ventricular Dilation, SHLeft Ventricular Hypertrophy +14 more
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Pulsus Paradoxus
aka Paradoxical pulse
Rule in:SHAsthma Exacerbation, SHCardiac Tamponade, IEChronic Obstructive Pulmonary Disease Exacerbation +2 more
Rule out:VHCardiac Tamponade, SHAsthma Exacerbation, IEChronic Obstructive Pulmonary Disease Exacerbation +2 more