Physical Exam

Chest Percussion

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Video coming September 2026

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

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:Limited

Chronic Obstructive Pulmonary Disease

Hyperresonance to percussion in an adult with respiratory symptoms

Rule in

Somewhat helpfulNo CI

Rule out

Not helpfulNo CI

Evidence:Limited

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:Limited

Pleural Effusion

Dullness to conventional percussion over the affected hemithorax

Rule in

Helpful

Rule out

InconclusiveWide CI

Evidence:Strong

Pneumonia

Lobar Pneumonia

Dullness to percussion

Rule in

Somewhat helpful

Rule out

Not helpful

Evidence:Strong

References

Holleman DR Jr, Simel DL. Does the clinical examination predict airflow limitation? JAMA. 1995;273(4):313-319. doi:10.1001/jama.1995.03520280059041. PMID 7815660.
Oshaug K, Halvorsen PA, Melbye H. Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease? Int J Chron Obstruct Pulmon Dis. 2013;8:369-377. PMID 23983462. PMC3751499 (open access). [Closest candidate only — different target.]
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. PMID: 19155458.
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. PMID 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.
Bohadana AB, Coimbra FTV, Santiago JRF. Detection of lung abnormalities by auscultatory percussion: a comparative study with conventional percussion. Respiration. 1986;50(3):218-225. PMID: 3797828.
Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL. Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? Am J Med. 1993;94(2):188-196. doi:10.1016/0002-9343(93)90182-O. PMID: 8430714.
Holleman DR Jr, Simel DL. Does the clinical examination predict airflow limitation? JAMA. 1995;273(4):313-319. doi:10.1001/jama.1995.03520280059041. PMID: 7815660.
Heckerling PS, Wiener SL, Moses VK, Claudio J, Kushner MS, Hand R. Accuracy of precordial percussion in detecting cardiomegaly. Am J Med. 1991;91(4):328-334. PMID: 1835287.
Heckerling PS, Wiener SL, Wolfkiel CJ, Kushner MS, Dodin EM, Jelnin V, Fusman B, Chomka EV. Accuracy and reproducibility of precordial percussion and palpation for detecting increased left ventricular end-diastolic volume and mass: a comparison of physical findings and ultrafast computed tomography of the heart. JAMA. 1993;270(16):1943-1948. PMID: 8411551.
Auenbrugger L. Inventum Novum ex Percussione Thoracis Humani ut Signo Abstrusos Interni Pectoris Morbos Detegendi. Vienna: Trattner; 1761.

Research last updated September 9, 2026.