Pleural effusion physical examination: Difference between revisions
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{{CMG}}; {{GCC}} | {{CMG}}; {{GCC}} | ||
==Physical Examination== | ==Physical Examination<ref name="isbn0-7817-6957-4">{{cite book | author = Light, Richard J. | authorlink = | editor = | others = | title = Pleural diseases | edition = | language = | publisher = Lippincott Williams & Wilkins | location = Hagerstwon, MD | year = 2007 |origyear = | pages = | quote = | isbn = 0-7817-6957-4 | oclc = | doi = |url = | accessdate = }}</ref>== | ||
When only 250 to | 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: | At a pleural fluid volume of approximately 500 ml, the typical physical findings are: | ||
* Dullness to [[percussion]] | * Dullness to [[percussion]] | ||
* Decreased [[fremitus]] | * Decreased [[fremitus]] | ||
* Normal vesicular [[breath sounds]] of decreased intensity compared with the contralateral side | * Normal vesicular [[breath sounds]] of decreased intensity compared with the contralateral side | ||
At a pleural fluid volume exceeding | At a pleural fluid volume exceeding 1000 ml, there usually is: | ||
* Absence of inspiratory retraction | * Absence of inspiratory retraction | ||
* Mild bulging of the intercostal spaces | |||
* Decreased expansion of the ipsilateral chest wall | * Decreased expansion of the ipsilateral chest wall | ||
* Dullness to [[percussion]] up to the level of the scapula and axilla | * Dullness to [[percussion]] up to the level of the scapula and axilla | ||
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* [[Egophony]] 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: | When the effusion fills the entire hemithorax, physical examination will show: | ||
* Bulging of the intracostal spaces | * Bulging of the intracostal spaces | ||
* Minimal to no expansion of the ipsilateral chest wall | * Minimal to no expansion of the ipsilateral chest wall | ||
Revision as of 11:52, 2 May 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Template:GCC
Physical Examination[1]
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:
- Dullness to percussion
- Decreased fremitus
- Normal vesicular breath sounds of decreased intensity compared with the contralateral side
At a pleural fluid volume exceeding 1000 ml, there usually is:
- Absence of inspiratory retraction
- Mild bulging of the intercostal spaces
- Decreased expansion of the ipsilateral chest wall
- Dullness to percussion up to the level of the scapula and axilla
- Decreased or absent fremitus posteriorly and laterally
- 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
- Apalpable liver or spleen due to significant diaphragmatic depression
References
- ↑ Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.