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 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.