It is used to determine the boundaries of the lungs, the width of the apexes of the lungs (Kroenig's fields), and the mobility of the lower edge of the lungs. First, the lower boundaries of the lungs are determined. Percussion is carried out from top to bottom along symmetrical topographic lines on the left and right (Fig. 23). However, on the left it is usually not determined by two lines - parasternal (parasternal) and midclavicular. In the first case, this is due to the fact that the border of relative cardiac dullness begins from the third rib on the left and, thus, this level does not reflect the true border of the lung. As for the midclavicular line, determining the lower border of the lung along it is difficult due to tympanitis above Traube’s space (a gas bubble in the area of the vault of the stomach). When determining the lower boundaries, a plessimeter finger is placed in the intercostal spaces parallel to the ribs, moving it down until the sound is dull. The latter is formed during the transition from the lower edge of the lung to the diaphragm and hepatic dullness. The boundary mark is drawn along the edge of the finger facing the clear sound.
In normosthenics, the lower border of the lungs has the following location.
Since percussion is carried out along the intercostal spaces, to clarify the border of the lungs it is necessary to double-check it along the ribs.
To determine the height of the apex in front, a finger-pessimeter is placed in the supraclavicular fossa parallel to the clavicles and, along the course of percussion, is moved upward and medially towards the scalene muscles. Normally, the height of the apex in front is 3-4 cm above the collarbones, while the left apex is often located 0.5-1 cm higher than the right.
Rice. 23. Determination of the lower border of the right lung.
To determine the height of the apexes at the back, a finger-pessimeter is placed parallel to the spines of the scapula and percussed upward and inward towards the spinous process VII cervical vertebra(Fig. 24).
Normally, the apexes at the back are on a line passing through this process. The width of the apexes, or Krenig's fields, is determined by percussion along the anterior edge of m. trapecius. To do this, a plessimeter finger is placed in the middle of this muscle perpendicular to its edge, and then percussed inward and outward until dull. Normally, the width of Krenig’s fields is 5-6 cm, but can vary depending on the type of constitution from 3 to 8 cm.
The height and width of the apices most often increases with emphysema, while a decrease is noted with shrinking processes in the lungs: tuberculosis, cancer, pneumosclerosis.
Rice. 24 Determination of the standing height of the apexes of the lungs from behind and in front.
Most often, changes occur in the lower border of the lungs. Its bilateral descent occurs during an attack of bronchial asthma or chronic pulmonary emphysema. A unilateral downward displacement can occur with replacement emphysema of one lung against the background of the other being switched off from the act of breathing. This happens when exudative pleurisy, hydrothorax, pneumothorax.
An upward displacement of the lower border is often unilateral and occurs when: shrinkage of the lung due to pneumosclerosis or cirrhosis; obstructive atelectasis due to complete blockage of the lower lobe bronchus by a tumor; accumulation of fluid or air in the pleural cavity, which pushes the lungs upward; a sharp enlargement of the liver or spleen. With severe ascites and flatulence, at the end of pregnancy there may be a confusion of the lower border of the lungs on both sides.
The mobility of the lower edge of the lung is determined by percussion of the lower border of the lung during deep inspiration and deep exhalation. This is usually done along three topographic lines on the right (midclavicular, middle axillary and scapular) and two lines on the left (middle axillary and scapular). First, determine the lower border of the lungs along the indicated lines during quiet breathing, then, after a deep inhalation and holding your breath, continue percussion downwards until dullness and make a second mark. After this, the patient is asked to hold his breath while exhaling deeply (in this case, the edge of the lung moves upward) and the new position of the lower edge of the lung is also determined by percussion from top to bottom. This means that in any situation the bottom edge light is better determine by percussion from a clear pulmonary sound to dullness or dullness. Normally, the mobility of the lower edge of the lung along the right midclavicular and scapular lines is 4-6 cm (2-3 cm each on inhalation and exhalation), along the middle axillary lines - 8 cm (3-4 cm each on inhalation and exhalation).
Diagnosis of the respiratory system necessarily includes percussion. This is a procedure that evaluates the sound produced during chest tapping.. With its help, you can identify various abnormalities in the lung area (comparative), as well as find out where the boundaries of the organ end (topographic percussion).
To obtain a more accurate result, the patient should stand upright with his arms down when examining the front of the chest. While palpating the back, the patient should cross his arms in the chest area and lean forward slightly.
It is necessary to distinguish between percussion and auscultation of the lungs. During auscultation, the organ is simply audible during the patient's natural breathing. Usually the procedure is carried out to detect any noise in the lungs (helps to identify pneumonia, bronchitis, tuberculosis and other diseases). But during percussion, the doctor taps to hear certain sounds.
Description and methods of the procedure
Lung percussion is a process that is based on the possibility elastic bodies give vibrations when struck. And if there is any obstacle in the path of the wave, the sound will begin to intensify. Based on this, conclusions are drawn regarding the presence of any lung diseases in the patient.
There are several main methods for performing the procedure:
- Indirect, in which the doctor places his middle finger on the chest and then taps it index finger second hand.
- Yanovsky's technique. It involves tapping the flesh of the finger on the phalanx of the finger attached to the chest. This technique is usually used when examining infants, as it is the least traumatic.
- Ebstein's technique. In this case, the doctor gently taps the organ with the pulp of the terminal phalanx of any finger.
- Obraztsov's technique. The procedure is carried out using a weak blow - the nail phalanx slides over the adjacent finger, after which the blow is performed.
Another option for percussion is a slight tap on the back with a fist. This procedure is aimed at identifying pain in the lung area.
Types of lung percussion
Depending on the purpose of the procedure, there are two main types: topographical and comparative. In the first case, the boundaries of the lungs are assessed, and in the second, various pathologies organ.
Topographical survey
Topographic percussion of the lungs is aimed at determining the lower boundaries of the organ, its width, and height. Be sure to measure both parameters on both sides - front and back.
The doctor gently strikes within the chest, from top to bottom. When there is a transition from a clear sound to a dull sound, the border of the organ will be located in this place. After this, the found points of percussion of the lungs are recorded with a finger, after which it is necessary to find their coordinates.
You can take the necessary measurements with your fingers. However, to do this, you should know in advance their exact size - the width and length of the phalanges.
Determination of the lower border of the lungs is performed using vertical identification lines. The process begins with the anterior axillary lines. The doctor faces the patient, instructs him to raise his hands and place them behind his head. After this, he begins to tap from top to bottom in a vertical straight line, starting from the armpits and ending with the hypochondrium. The doctor taps in the area of the ribs, listening carefully to the sounds produced to determine exactly where the transition zone between clear and muffled sounds is located.
It must be taken into account that it may be difficult to determine the boundaries of the left lung. Indeed, in the area of the axillary line there is also another noise - heartbeat. Because of the extraneous sound, it is difficult to determine at what point the clear sound is replaced by a dull one.
Then the procedure is repeated, but on the back. The doctor stands behind the patient, and at the same time the patient should put his hands down, relax and breathe calmly. After this, the doctor taps from the bottom of the scapula, reaching the spinal column and lowers down.
The localization of the organ is indicated by the ribs. The count starts from the collarbone, nipple, lower border of the scapula or the lowest 12th rib (the results of the study must indicate from which rib the count started).
When determining the location of the lungs with reverse side the starting point is the vertebrae. This is due to the fact that the ribs on the back are difficult to palpate, as muscles prevent this.
Normally, the lower border of the right lung should have the following coordinates: 6th rib along the midclavicular line, 7th rib along the anterior axillary line, 8th along the middle and 9th rib along the posterior axillary line. But the lower border of the left organ falls on the 7th rib of the anterior axillary line, the 9th rib of the middle and posterior axillary line. From the back, the lower border of both lungs runs along the 11th thoracic vertebra.
Usually, in normosthenics, the lung boundaries are normal – they correspond to the above parameters. But for hypersthenics and asthenics these indicators differ. In the first case, the lower boundaries are located one edge higher, and in the second - one edge lower.
If a person has a normal physique, but the lungs are in the wrong position, we are talking about some kind of disease.
When the borders of both lungs sag, emphysema is often diagnosed. In addition, the pathology can be unilateral, developing only on the left or right side. This condition is often caused by the formation postoperative scars in the area of one organ.
Simultaneous elevation of both lungs can be caused by increased intra-abdominal pressure. This phenomenon is often associated with excess weight, chronic flatulence and other pathological conditions in the body.
When a large amount of fluid accumulates in the pleural cavity (more than 450 ml), the lungs shift upward. Therefore, in this area, instead of a clear sound, a muffled sound is heard. If there is too much fluid in the pleural cavity, a dull sound is heard over the entire surface of the lungs.
It must be taken into account that if the dullness extends to both lungs at once, this indicates the accumulation of transudate in the area of them. But if a clear sound is heard in one of the lungs, and a dull sound in the second, we are talking about the accumulation of purulent effusion.
The standing height of the pulmonary apexes is also determined from both sides - back and front. The doctor stands in front of the patient, who must stand straight and be completely motionless. Then the doctor places his finger in the supraclavicular fossa, but always parallel to the collarbone. Begins to gently strike the finger from top to bottom at a distance of 1 cm between each strike. But at the same time, the horizontal position of the finger must be maintained.
When a transition from a clear sound to a dull sound is detected, the doctor holds the finger in this place, and then measures the distance from the middle phalanx to the middle of the clavicle. If there are no deviations, this distance should be approximately 3-4 cm.
To determine the height of the apex from the back, palpation of the lungs and percussion begins from the center of the lower part of the scapula, moving upward. In this case, after each percussion blow, the finger rises up by about 1 cm, but its position must be horizontal. When the point of transition from clear to dull sound is found, the doctor fixes it with a finger and asks the patient to lean forward to better see the seventh cervical vertebra. Normally, the upper border of the lungs should pass at this level.
Typically, when performing pulmonary percussion, blows of medium strength are necessary, since if they are too weak, they may not reach the surface of the organ.
The procedure is performed according to the following scheme:
- The doctor faces the patient. In this case, the patient should be standing or sitting, but always with a straight back.
- Then percussion of both supraclavicular fossae begins. For this purpose, the finger is placed parallel to the collarbone, a few cm above it.
- The collarbones are tapped using a finger.
- Then percussion is carried out along the midclavicular lines in the area of the first and second intercostal spaces. On the left side, percussion is not performed, since cardiac dullness interferes with the process here. The sounds of the heart drown out the sound of the lungs made when tapping.
- From the side, percussion is carried out along the axillary lines. In this case, the patient should raise his hands up and place them behind his head.
- To perform a back examination, the doctor stands behind the patient. In this case, the patient himself should lean forward slightly, lowering his head down and crossing his arms in front of his chest. Due to this position, the shoulder blades diverge to the side, so the space between them expands. First, the doctor begins to percuss the area above the shoulder blades, and then successively moves down.
If instead of a clear sound a dull sound is produced, it is necessary to indicate the localization of this area in medical card patient. Dullness of sound may indicate that the lung tissue is compacted, so airiness in the percussion zone is reduced. This condition indicates pneumonia, tumors of the respiratory organ, tuberculosis and other diseases.
A dull sound is usually quieter, has a higher pitch and shorter duration compared to a clear sound. In the case of fluid accumulation in the pleural cavity, the sound produced resembles that obtained during percussion of the femoral muscles.
Percussion in children
Comparative percussion of the lungs in children is carried out according to the same algorithm as in adults. But during it you must follow a number of rules:
- The room should be warm so that the child does not catch a cold.
- The baby should be in a position that is comfortable for him.
- The doctor should also take a comfortable position to perform the procedure as quickly as possible.
- The doctor's hands should be warm and the nails should be cut so as not to injure the child's skin.
- Strikes should be short and insignificant.
- The results of the study must be recorded in the medical record.
Topographic percussion of the lungs in children is carried out in compliance with the same rules. Unlike percussion in adults, the norm for children varies and depends on age.
Table by age
Percussion is very important procedure, which is carried out for diagnostic purposes, as well as to prevent the development of certain diseases. In children under 10 years of age, the procedure is recommended to be performed annually to monitor lung development. Then the check can be performed once every 5-10 years for preventive purposes, and, as necessary, for diagnostic purposes.
There are two types of lung percussion: topographic and comparative.
Topographic percussion of the lungs
Topographic percussion of the lungs includes the topography of the apexes of the lungs, the topography of the lower edge of the lungs and determination of the mobility of the lower pulmonary edge, as well as the topography of the lobes of the lung.
In front, percussion is carried out from the middle of the clavicle upward and medially towards the mastoid process. Normally, the apex of the lung is 3–5 cm above the collarbone. If there are well-defined supraclavicular fossae, percussion is performed along the nail phalanx. Behind the boundary is determined from the middle of the spine of the scapula towards the spinous process of the VIIth cervical vertebra, at the level of which it is normal.
Determining the width of the apexes of the lungs or Kroenig's fields also has diagnostic value. They are determined from both sides, since it is important to evaluate their symmetry. Percussion is carried out along the upper edge of the trapezius muscle from its middle - medially and laterally. Normally, their value is 4–8 cm. When the apex of the lung is affected by the tuberculosis process with the development of fibrosis, the size of the Kroenig field decreases on the affected side, and with pulmonary emphysema it increases on both sides. The standards for the lower limit of the lungs are given in Table 3.
Table 3
Standards for the lower limit of the lungs
|
Topographic lines |
On right |
Left |
|
By midclavicular |
Not defined |
|
|
Anterior axillary | ||
|
Middle axillary | ||
|
Posterior axillary | ||
|
Along the scapular | ||
|
Along the paravertebral |
11th rib (or spinous process of the XI thoracic vertebra) |
|
In severe hypersthenics, the lower edge may be one rib higher, and in asthenics – one rib lower.
The mobility of the lower pulmonary edge is determined by percussion along each topographic line, always during inhalation and exhalation. First, the lower border of the lung is determined during quiet breathing, then the patient is asked to take a deep breath and, while holding his breath, he percusses further until the percussion sound becomes dull. Then the patient is asked to exhale completely and is also percussed from top to bottom until the sound becomes dull. The distance between the boundaries of the resulting dullness on inhalation and exhalation corresponds to the mobility of the pulmonary edge. Along the axillary lines, it is 6–8 cm. When assessing the mobility of the lower edges of the lungs, it is important to pay attention not only to their size, but also to their symmetry. Asymmetry is observed in unilateral inflammatory processes (pneumonia, pleurisy, in the presence of adhesions), and a bilateral decrease is characteristic of pulmonary emphysema,
Comparative percussion of the lungs
Comparative percussion of the lungs is carried out sequentially along the anterior, lateral and posterior surfaces of the lungs. When conducting comparative percussion, the following conditions must be observed:
a) perform percussion in strictly symmetrical areas;
b) observe the identical conditions, meaning the position of the pessimeter finger, pressure on chest wall and the strength of percussion blows. Percussion of medium strength is usually used, but when identifying a focus located deep in the lung, strong percussion blows are used.
In front, percussion begins from the supraclavicular fossa, with the pessimeter finger positioned parallel to the clavicle. Then the clavicle itself and the areas of the 1st and 2nd intercostal spaces are percussed along the midclavicular lines, while the pessimeter finger is located along the intercostal spaces.
On the lateral surfaces, comparative percussion is carried out along the anterior, middle and posterior axillary lines, with the patient’s arms raised. When percussing the posterior surface of the lungs, the patient is asked to cross his arms over his chest, while the shoulder blades diverge and the interscapular space increases. First, the suprascapular space is percussed (the plessimeter finger is placed parallel to the spine of the scapula). Then the interscapular space is sequentially percussed (the pessimeter finger is placed parallel to the spine). IN subscapular region percussion first paravertebral, and then along the scapular lines, placing the plessimeter finger parallel to the ribs.
Normally, with comparative percussion, it is reproduced clear lung sound basically the same in symmetrical areas of the chest, although it should be remembered that on the right the percussion sound is more muffled than on the left, since the apex of the right lung is located below the left and the muscles of the shoulder girdle in most patients on the right are more developed than on the left and partially dampen the sound.
A dull or dull pulmonary sound is observed when the airiness of the lung decreases (infiltration of lung tissue), the accumulation of fluid in the pleural cavity, when the lung collapses (atelectasis), or when there is a cavity in the lung filled with liquid contents.
Tympanic percussion sound is determined by increased airiness of the lung tissue (acute and chronic emphysema), which is observed in various cavity formations: cavity, abscess, as well as accumulation of air in the pleural cavity (pneumothorax).
A dull tympanic sound occurs when the elasticity of the lung tissue decreases and its airiness increases. Similar conditions arise with pneumococcal (lobar) pneumonia (the stage of influx and the stage of resolution), in the area of the Skoda strip with exudative pleurisy, with obstructive atelectasis.
Determining the boundaries of the lungs has great importance for the diagnosis of many pathological conditions. The ability to percussion detect displacement of the chest organs in one direction or another allows one to suspect the presence of a certain disease already at the stage of examining the patient without the use of additional research methods (in particular, x-ray).
How to measure the boundaries of the lungs?
Of course you can use instrumental methods diagnostics, make X-ray and use it to evaluate how the lungs are located relative to the bone frame of the chest. However, this is best done without exposing the patient to radiation.
Determination of the boundaries of the lungs at the examination stage is carried out using the method topographic percussion. What it is? Percussion is a study that is based on identifying the sounds that arise when tapping on the surface of the human body. The sound changes depending on the area in which the research takes place. Over parenchymal organs (liver) or muscles it becomes dull, over hollow organs (intestines) it becomes tympanic, and over air-filled lungs it acquires a special sound (pulmonary percussion sound).
Performed this study in the following way. One hand is placed with the palm on the area of study, two or one fingers of the second hand hit the middle finger of the first (plesimeter), like a hammer on an anvil. As a result, you can hear one of the variants of percussion sound, which were already mentioned above. Percussion can be comparative (sound is assessed in symmetrical areas of the chest) and topographic. The latter is precisely intended to determine the boundaries of the lungs.
How to properly perform topographic percussion?
The pessimeter finger is installed at the point from which the study begins (for example, when determining the upper border of the lung along the anterior surface, it begins above the middle part of the clavicle), and then moves to the point where approximately this measurement should end. The limit is determined in the area where the pulmonary percussion sound becomes dull.
For ease of research, the pessimeter finger should lie parallel to the desired boundary. The displacement step is approximately 1 cm. Topographic percussion, unlike comparative, is performed by gentle (quiet) tapping.
Upper limit
The position of the apexes of the lungs is assessed both anteriorly and posteriorly. On the front surface of the chest, the clavicle serves as a reference point, on the back - the seventh cervical vertebra (it has a long spinous process, by which it can be easily distinguished from other vertebrae). The upper boundaries of the lungs are normally located as follows:
Research should be performed as follows:
Displacement of the upper borders of the lungs
An upward shift of the boundaries occurs due to excessive airiness of the lung tissue. This condition is characteristic of emphysema, a disease in which the walls of the alveoli are overstretched, and in some cases, their destruction with the formation of cavities (bullas). Changes in the lungs with emphysema are irreversible, the alveoli are swollen, the ability to collapse is lost, elasticity is sharply reduced. Boundaries of the human lungs (in in this case limits of the apex) can move downwards. This is due to a decrease in the airiness of the lung tissue, a condition that is a sign of inflammation or its consequences (proliferation connective tissue and shrinkage of the lung). Borders of the lungs (upper), located below normal level, – diagnostic sign pathologies such as tuberculosis, pneumonia, pneumosclerosis.
Bottom line
To measure it, you need to know the main topographic lines of the chest. The method is based on moving the researcher's hands along the indicated lines from top to bottom until the percussion pulmonary sound changes to dull. You should also know that the anterior border of the left lung is not symmetrical to the right due to the presence of a pocket for the heart.
In front, the lower borders of the lungs are determined by a line running along the lateral surface of the sternum, as well as along a line going down from the middle of the clavicle. From the side, important landmarks are the three axillary lines - anterior, middle and posterior, which start from the anterior edge, center and posterior edge armpit respectively. The posterior edge of the lungs is defined relative to a line that descends from the angle of the scapula and a line located on the side of the spine.
Displacement of the lower borders of the lungs
It should be noted that during breathing the volume of this organ changes. Therefore, the lower borders of the lungs normally shift 20-40 mm up and down. A persistent change in the position of the border indicates pathological process in the chest or abdominal cavity.
The lungs become excessively enlarged with emphysema, which leads to a bilateral downward displacement of the boundaries. Other causes may be hypotension of the diaphragm and severe prolapse of the abdominal organs. The lower border shifts down from one side in the case of compensatory expansion of a healthy lung, when the second is in a collapsed state as a result, for example, of total pneumothorax, hydrothorax, etc.
The borders of the lungs usually move upward due to wrinkling of the latter (pneumosclerosis), collapse of the lobe as a result of bronchial obstruction, and accumulation of exudate in the pleural cavity (as a result of which the lung collapses and is pressed towards the root). Pathological conditions in the abdominal cavity can also shift the pulmonary boundaries upward: for example, accumulation of fluid (ascites) or air (with perforation of a hollow organ).
Normal lung boundaries: table
Lower limits in an adult
Field of study
Right lung
Left lung
Line at the lateral surface of the sternum
5th intercostal space
-
A line descending from the middle of the collarbone
6 rib
-
A line originating from the anterior edge of the axilla
7th rib
7th rib
A line extending from the center of the armpit
8 rib
8 rib
Line from the posterior edge of the armpit
9 rib
9 rib
Line descending from the angle of the scapula
10 rib
10 rib
Line on the side of the spine
11th thoracic vertebra
11th thoracic vertebra
The location of the upper pulmonary borders is described above.
Changes in indicator depending on body type
In asthenics, the lungs are elongated in the longitudinal direction, so they often fall slightly below the generally accepted norm, ending not at the ribs, but in the intercostal spaces. Hypersthenics, on the contrary, are characterized by a higher position of the lower border. Their lungs are wide and flattened in shape.
How are the pulmonary boundaries located in a child?
Strictly speaking, the boundaries of the lungs in children practically correspond to those of an adult. The tops of this organ are in guys who have not yet reached preschool age, which are not defined. Later they appear in front 20-40 mm above the middle of the collarbone, in the back - at the level of the seventh cervical vertebra.
The location of the lower boundaries is discussed in the table below.
Boundaries of the lungs (table)
Field of study
Age up to 10 years
Age over 10 years
Line running from the middle of the collarbone
Right: 6th rib
Right: 6th rib
A line starting from the center of the armpit
Right: 7-8 rib Left: 9 rib
Right: 8th rib Left: 8th rib
Line descending from the angle of the scapula
Right: 9-10 rib Left: 10 rib
Right: 10th rib Left: 10th rib
Reasons for displacement of the pulmonary boundaries in children up or down relative to normal values the same as in adults.
How to determine the mobility of the lower edge of the organ?
It was already mentioned above that when breathing, the lower boundaries shift relative to normal indicators due to the expansion of the lungs on inhalation and decrease on exhalation. Normally, such a shift is possible within 20-40 mm up from the lower border and the same amount down. Determination of mobility is carried out by three main lines, starting from the middle of the collarbone, the center of the armpit and the angle of the scapula. Research is carried out as follows. First, determine the position of the lower border and make a mark on the skin (you can use a pen). The patient is then asked to take a deep breath and hold his breath, after which the lower limit is again found and a mark is made. And finally, determine the position of the lung at maximum exhalation. Now, based on the estimates, we can judge how the lung shifts along its lower border. In some diseases, lung mobility is noticeably reduced. For example, this occurs during adhesions or large quantities exudate in pleural cavities, loss of lung elasticity due to emphysema, etc.
Difficulties in performing topographic percussion
This research method is not easy and requires certain skills, and better yet, experience. Complications that arise during its use are usually associated with incorrect execution technique. Concerning anatomical features that can create problems for the researcher, mainly severe obesity. In general, it is easiest to perform percussion on asthenics. The sound is clear and loud.
What needs to be done to easily determine the boundaries of the lung?
And, of course, experience is very important. Practice gives you confidence in your abilities.
Summarize
Percussion is a very important diagnostic method. It allows one to suspect many pathological conditions chest organs. Deviations of the borders of the lungs from normal values, impaired mobility of the lower edge are symptoms of some serious illnesses, timely diagnosis which is important for complete treatment.
Topographic percussion of the lungs is a method of physical diagnosis based on percussion of the chest and assessment of the sounds that occur during the procedure. By the nature of sound vibrations they determine physical state, size, location of the organ of the respiratory system.
Methods for measuring the border of the lungs
Topographic percussion allows you to determine the position of the lungs in the chest relative to nearby internal organs. This can be achieved due to the difference between the sounds that arise when tapping the airy lung tissue and denser structures that do not contain air. The study includes sequential clarification of the height of the tops, the width of the fields, the lower borders and the mobility of the lobar edges.
Lung topography is carried out using several percussion methods:
- deep;
- superficial.
The deep tapping method makes it possible to identify organ parameters, pathological compactions, respiratory sounds, and neoplasms located deep in the parenchyma. A superficial diagnostic method helps to distinguish between air-containing and airless tissues, to determine the localization of pathological foci and cavities.
Rules for performing percussion
The diagnostic procedure is performed by a pulmonologist according to the following rules:
- topographic percussion is carried out in the direction from a clear pulmonary sound to a dull one;
- The doctor places the pessimeter finger parallel to the expected edge of the lungs;
- the limit line corresponds to the outer edge of the finger from the side internal organ, giving a clear percussion sound;
- First superficial and then deep percussion is used.
Topographic percussion of the lungs is carried out in a warm room, the person should be completely relaxed, breathing should be calm. During the study, the patient stands or sits, with the exception of bedridden patients. The doctor places the plessimeter finger firmly on the body, but does not allow the phalanx to be immersed too deeply in soft fabrics so as not to provoke increased sound vibration.
Upper limits
To localize the height of the pulmonary apexes, a plessimeter is placed in the supraclavicular fossa parallel to the clavicular bone. Apply several blows with a hammer finger, then raise the plessimeter so that the nail rests against the edge of the cervical sternocleidomastoid muscle. Continue topographic percussion along the clavicular line until the percussion sound changes from loud to dull. Using a centimeter tape or ruler, measure the distance from the middle of the collarbone to the apexes determined during the study.
Reasons for shifting the upper limits
The apexes are raised above normal in emphysema, bronchial asthma, and are omitted during sclerosis of the respiratory organ, for example, with tuberculosis, the formation of foci of infiltration. A downward displacement of the apexes is observed with a decrease in airiness, pneumonia, and pneumosclerosis.
Determination of the parameters of the lower boundaries begins with tapping the right lung along the parasternal (parasternal) line.
To carry out diagnostics, the topographic lines of the chest are examined: mamillary (midclavicular), scapular - under the angulus inferior, axillary, located at the height of the armpit, paravertebral - in the projection of the spine of the scapula.
The parameters of the left lung are determined in an identical way, with the exception of tapping the parasternal and midclavicular line. This is due to the close location of the heart and the influence of the gastric bubble on the dulling of sound. When performing topographic percussion from the front upper limbs the patient is lowered down, when tapping the axillary area, they are raised above the head.
Drooping of the lower edges may be a symptom of a low diaphragm or emphysema. Raising is noted with wrinkling, scarring of the lung tissue against the background lobar pneumonia, hydrothorax, exudative pleurisy.
High intra-abdominal pressure, pregnancy, flatulence, ascites, excessive deposition of visceral fat can cause the diaphragm to stand high, raising the lower edges. Displacement of the lower edges also occurs when cancerous tumors, a sharp increase in liver size.
Normal location of the lung boundaries
U healthy person the standing height of the apexes on the anterior side of the body is fixed at 3–4 cm above the clavicular bone, and at the rear it corresponds to the level of the transverse spinous process of the seventh cervical vertebra - C7.
Normal lower limits:
Measuring the indicator taking into account body features
In hypersthenics with a large chest and long torso, it is allowed to raise the lower edges of the lungs by one costal arch, and in asthenics, the lower edge is lowered by one rib below the physiological norm.
