Pleural effusion physical examination: Difference between revisions

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Revision as of 20:54, 4 May 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Template:GCC

Overview

Physical signs for pleural effusions are first recognized by Josef Leopold Auenbrugger, who described the dullness on percussion and diminished chest expansion,^[1] and René-Théophile-Hyacinthe Laennec, who introduced the abnormal vocal resonance and bronchial breath sounds in patients with effusions.^[2] Excessive accumulation of fluids in the pleural cavity widens the hemithorax and collapses the involved lungs, which produces asymmetrical chest expansion with reduced breath sounds. Pleural fluid also interferes with the transmission of low-frequency vibrations and results in diminished tactile fremitus. Physical findings for pleural effusions are determined by the volume of fluids and the extent of lung compression. Asymmetric chest expansion, diminished fremitus, dullness on percussion, decreased or absent breath sounds, and reduced vocal resonance were reported to have a sensitivity and specificity of 74% and 91%, 82% and 86%, 89% and 81%, 88% and 83%, and 76% and 88%, respectively.^[3]

Physical findings based on pleural fluid volume^[4]

Pleural fluid volume	Physical findings
250 to 300 ml	May be unremarkable
500 ml	Decreased intensity of breath sounds Dullness to percussion Decreased fremitus
1000 ml	Absence of inspiratory retraction Mild bulging of the intercostal spaces Decreased chest expansion Bronchovesicular breath sounds of decreased intensity Egophony Dullness to percussion up to the level of the scapula and axilla Decreased or absent fremitus posteriorly and laterally
The entire hemithorax filled	No expansion of the chest wall Bulging of the intercostal spaces Minimal bronchovesicular breath sounds Egophony Dullness to percussion over the entire hemithorax A palpable liver or spleen due to diaphragmatic depression

References

↑ Auenbrugger, Leopold (1763). Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi. Vindobonae : Typis Joannis Thomae Trattner, MDCCLXIII.
↑ Laennec, René-Théophile-Hyacinthe (1823). A treatise on the diseases of the chest :in which they are described according to their anatomical characters, and their diagnosis, established on a new principle by means of acoustic instruments.
↑ Kalantri S, Joshi R, Lokhande T; et al. (2007). "Accuracy and reliability of physical signs in the diagnosis of pleural effusion". Respir Med. 101 (3): 431–8. doi:10.1016/j.rmed.2006.07.014. PMID 16965906. Unknown parameter |month= ignored (help)
↑ Leopold SS; Hopkins HU (1965). Principles and methods of physical diagnosis (3rd ed.). W.B. Saunders. ISBN 0721647707.

Template:WH Template:WS

[1] Auenbrugger, Leopold (1763). Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi. Vindobonae : Typis Joannis Thomae Trattner, MDCCLXIII.

[2] Laennec, René-Théophile-Hyacinthe (1823). A treatise on the diseases of the chest :in which they are described according to their anatomical characters, and their diagnosis, established on a new principle by means of acoustic instruments.

[pmid16965906-3] Kalantri S, Joshi R, Lokhande T; et al. (2007). "Accuracy and reliability of physical signs in the diagnosis of pleural effusion". Respir Med. 101 (3): 431–8. doi:10.1016/j.rmed.2006.07.014. PMID 16965906. Unknown parameter |month= ignored (help)

[4] Leopold SS; Hopkins HU (1965). Principles and methods of physical diagnosis (3rd ed.). W.B. Saunders. ISBN 0721647707.

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[2]

[3]

[4]

@@ Line 6: / Line 6: @@
 Physical signs for pleural effusions are first recognized by Josef Leopold Auenbrugger, who described the dullness on percussion and diminished chest expansion,<ref>{{cite book|last=Auenbrugger|first=Leopold|title=Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi. Vindobonae : Typis Joannis Thomae Trattner, MDCCLXIII|url=http://pds.lib.harvard.edu/pds/view/7780304|year=1763}}</ref> and René-Théophile-Hyacinthe Laennec, who introduced the abnormal vocal resonance and bronchial breath sounds in patients with effusions.<ref>{{cite book|last=Laennec|first=René-Théophile-Hyacinthe|title=A treatise on the diseases of the chest :in which they are described according to their anatomical characters, and their diagnosis, established on a new principle by means of acoustic instruments. |url=http://pds.lib.harvard.edu/pds/view/7895001|year=1823}}</ref> Excessive accumulation of fluids in the pleural cavity widens the hemithorax and collapses the involved lungs, which produces asymmetrical chest expansion with reduced breath sounds. Pleural fluid also interferes with the transmission of low-frequency vibrations and results in diminished tactile fremitus. Physical findings for pleural effusions are determined by the volume of fluids and the extent of lung compression. Asymmetric chest expansion, diminished fremitus, dullness on percussion, decreased or absent breath sounds, and reduced vocal resonance were reported to have a sensitivity and specificity of 74% and 91%, 82% and 86%, 89% and 81%, 88% and 83%, and 76% and 88%, respectively.<ref name="pmid16965906">{{cite journal | author = Kalantri S, Joshi R, Lokhande T, ''et al.'' | title = Accuracy and reliability of physical signs in the diagnosis of pleural effusion | journal = Respir Med | volume = 101 |issue = 3 | pages = 431–8 | year = 2007 | month = March | pmid = 16965906 | doi = 10.1016/j.rmed.2006.07.014 | url = | issn =}}</ref>
-==Physical Examination<ref>{{cite book|author1=Leopold SS|author2=Hopkins HU|title=Principles and methods of physical diagnosis|edition=3rd|year=1965|publisher=W.B. Saunders|isbn=0721647707}}</ref>==
+===Physical findings based on pleural fluid volume<ref>{{cite book|author1=Leopold SS|author2=Hopkins HU|title=Principles and methods of physical diagnosis|edition=3rd|year=1965|publisher=W.B. Saunders|isbn=0721647707}}</ref>===
-When only 250 to 300 ml of pleural fluid is present, physical examination may be unremarkable.
-At a pleural fluid volume of approximately 500 ml, the typical physical findings are:
+{| style=width:80% border=2 bgcolor=FFFAFA
-* Dullness to [[percussion]]
+| style=width:20% height="20px" bgcolor=B0C4DE valign="top" |'''Pleural fluid volume'''
-* Decreased [[fremitus]]
+| style=width:80% height="20px" bgcolor=B0C4DE valign="top" |'''Physical findings'''
-* Normal vesicular [[breath sounds]] of decreased intensity compared with the contralateral side
+|-
+| valign="top"|250 to 300 ml||May be unremarkable
-At a pleural fluid volume exceeding 1000 ml, there usually is:
+|-
-* Absence of inspiratory retraction
+| valign="top"|500 ml||Decreased intensity of breath sounds<BR>Dullness to percussion<BR>Decreased fremitus
-* Mild bulging of the intercostal spaces
+|-
-* Decreased expansion of the ipsilateral chest wall
+| valign="top"| 1000 ml||Absence of inspiratory retraction<BR>Mild bulging of the intercostal spaces<BR>Decreased chest expansion<BR>Bronchovesicular breath sounds of decreased intensity<BR>Egophony<BR>Dullness to percussion up to the level of the scapula and axilla<BR>Decreased or absent fremitus posteriorly and laterally
-* Dullness to [[percussion]] up to the level of the scapula and axilla
+|-
-* Decreased or absent [[fremitus]] posteriorly and laterally
+| valign="top"| The entire hemithorax filled||No expansion of the chest wall<BR>Bulging of the intercostal spaces<BR>Minimal bronchovesicular breath sounds<BR>Egophony<BR>Dullness to percussion over the entire hemithorax<BR>A palpable liver or spleen due to diaphragmatic depression
-* Bronchovesicular [[breath sounds]], which may be of decreased intensity at the upper level of the effusion
+|}
-* [[Egophony]] at the upper level of the effusion
-When the effusion fills the entire hemithorax, physical examination will show:
-* Bulging of the intracostal spaces
-* Minimal to no expansion of the ipsilateral chest wall
-* A dull or flat [[percussion]] noted over the entire hemithorax
-* Absent [[breath sounds]] over the majority of the chest with possible bronchovesicular bronchial [[breath sounds]] at the apex
-* [[Egophony]] at the upper level of the pleural effusion
-* A palpable liver or spleen secondary to significant diaphragmatic depression
 ==References==

Pleural effusion physical examination: Difference between revisions

Revision as of 20:54, 4 May 2013

Overview

Physical findings based on pleural fluid volume[4]

References

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Physical findings based on pleural fluid volume^[4]