Pleural effusion physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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When only 250 to 300ml of pleural fluid is present, physical examination may be unremarkable.
At a pleural fluid volume of approximately 500 ml, the typical physical findings are:[1]
- Dullness to percussion
- Decreased fremitus
- Normal vesicular breath sounds of decreased intensity compared with the contralateral side
At a pleural fluid volume exceeding 1000ml, there usually is:[1]
- Absence of inspiratory retraction and 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:[1]
- 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
- ↑ 1.0 1.1 1.2 Light, Richard J. (2007). Pleural diseases. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-6957-4.