Pleural effusion physical examination
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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 Examination[4]
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
- A palpable liver or spleen secondary to significant 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.