It is used to determine the boundaries of the lungs, the width of the tops of the lungs (Krenig's field), 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 along two lines - the 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, it is difficult to determine the lower border of the lung along it because of tympanitis over the Traube space (gas bubble in the region of the fornix of the stomach). When determining the lower boundaries, the finger-plessimeter is placed in the intercostal space parallel to the ribs, moving it down to a dull sound. 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 normostenics, the lower border of the lungs has the following location.
Since percussion is carried out along the intercostal spaces, then to clarify the border of the lungs, it is necessary to double-check it along the ribs.
To determine the height of the apices from the front, the finger-plessimeter is placed in the supraclavicular fossa parallel to the clavicle and, along the percussion, is shifted upward and medially towards the scalene muscles. Normally, the height of the apices in front is 3-4 cm higher than the clavicles, while the left apex is often located 0.5-1 cm higher than the right.
Figure: 23. Determination of the lower border of the right lung.
To determine the standing height of the apexes from behind, the finger-plessimeter is placed parallel to the shoulder blades and percussed up and inward towards the spinous process of the VII cervical vertebra (Fig. 24).
Normally, the apexes at the back are on a line passing through this process. The width of the tops, or Kroenig fields, is determined by percussion along the front edge m. trapecius. To do this, a finger-plessimeter is placed in the middle of this muscle perpendicular to its edge, and then percussed inwards and outwards until dull. Normally, the width of Krenig's fields is 5-6 cm, but it can vary depending on the type of constitution from 3 to 8 cm.
The height and width of the tops most often increases with emphysema of the lungs, while their decrease is noted with wrinkling processes in the lungs: tuberculosis, cancer, pneumosclerosis.
Figure: 24 Determination of the height of the apexes of the lungs behind and in front.
Most often, changes occur in the lower border of the lungs. Bilateral omission of it occurs with an attack of bronchial asthma, chronic emphysema of the lungs. Unilateral downward displacement can be with replacement emphysema of one lung against the background of switching off the other from the act of breathing. This happens with exudative pleurisy, hydrothorax, pneumothorax.
The upward displacement of the lower border is more often one-sided and occurs when: lung wrinkling 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 push the lungs up; a sharp increase in the liver or spleen. With severe ascites and flatulence, at the end of pregnancy, there may be a mixing 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 inhalation 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, the lower border of the lungs is determined along the indicated lines with calm breathing, then after a deep breath and holding the breath, the percussion is continued down until dullness and a second mark is made. After this, the patient is asked to hold his breath on a deep exhalation (while the edge of the lung moves up) 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 lower edge of the lung is best determined by percussion from a clear lung 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 for inhalation and exhalation), along the middle axillary lines - 8 cm (3-4 cm for inhalation and exhalation).
Respiratory system diagnostics necessarily include percussion. It is a procedure that evaluates the sound that occurs when the chest is tapped.... With its help, you can identify various abnormalities in the lungs (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 hands down - when examining the front of the chest. During the probing of the back of the patient, the patient should cross his arms in the chest area and bend slightly forward.
It is necessary to distinguish between percussion and auscultation of the lungs. With auscultation, the organ is simply listened to during the patient's natural breathing. Usually, the procedure is carried out to detect any noises in the lungs (helps to identify pneumonia, bronchitis, tuberculosis and other diseases). But during percussion, the doctor performs tapping to hear certain sounds.
Description and methods of the procedure
Percussion of the lungs is a process that is based on the ability of elastic bodies to vibrate during impact. 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 of performing the procedure:
- Mediated, in which the doctor applies the middle finger to the chest, and then taps it with the index finger of the second hand.
- Yanovsky's technique. It consists in tapping the pulp 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 method. 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 with a weak blow - the nail phalanx slides over the adjacent finger, after which the blow is performed.
Another variant of percussion is a slight tapping of the fist on the back. This procedure is aimed at identifying pain in the lungs..
Varieties of lung percussion
Depending on the purpose of the procedure, there are two main types of it: topographic and comparative. In the first case, the boundaries of the lungs are assessed, and in the second, various pathologies of the organ are revealed..
Topographic survey
Topographic percussion of the lungs is aimed at determining the lower boundaries of the organ, its width, and also its height. Necessarily both parameters are measured on both sides - front and back.
The doctor strikes gently within the chest, from top to bottom. When a transition from a clear sound to a dull sound is observed, the organ boundary will be located in this place. After that, the found lung percussion points are fixed with a finger, after which it is necessary to find their coordinates.
You can take the necessary measurements with your fingers. However, for 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 stands facing the patient, instructs him to raise his hands and put them behind his head. After that, he begins to tap from top to bottom in a vertical line, starting from the armpits and ending with the hypochondria. The doctor taps on the ribs, carefully listening to the sounds emitted to determine exactly where the transition zone between clear and muffled sound is located.
Be aware that it can be difficult to define the boundaries of the left lung. Indeed, in the area of \u200b\u200bthe axillary line, another noise is observed - a heartbeat. Because of the extraneous sound, it is difficult to determine in what place a 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 must lower his hands down, relax and breathe calmly. After that, the doctor taps from the lower part of the scapula, reaching the spinal column and going down.
The localization of the organ is indicated by the ribs. The counting starts from the clavicle, nipple, the lower border of the scapula or the lowest 12th rib (the results of the study must indicate from which rib the count was started).
When determining the localization of the lungs from the back side, the vertebrae are the starting point. This is due to the fact that the ribs on the back are difficult to feel, as the muscles prevent this.
Normally, the lower border of the right lung should have the following coordinates: 6th rib along the mid-clavicular line, 7th rib along the anterior axillary line, 8th rib 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, 9th rib of the middle and posterior axillary lines. From the side of the back, the lower border of both lungs runs along the 11th vertebra of the thoracic region.
Usually, in normosthenics, the boundaries of the lungs are normal - they correspond to the above parameters. But in hypersthenics and asthenics, these indicators differ. In the first case, the lower boundaries are located one edge above, and in the second, one edge below.
If a person has a normal physique, but the lungs are in the wrong position, we are talking about any diseases.
When the borders of both lungs are omitted, emphysema is often diagnosed. In addition, the pathology can be one-sided, developing only on the left or right side. This condition is often caused by the formation of postoperative scars in the area of \u200b\u200bone organ.
The simultaneous elevation of both lungs can be caused by increased intra-abdominal pressure. This phenomenon is often associated with overweight, 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 move 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 should be borne in mind that if dullness is spread to both lungs at once, this indicates the accumulation of transudate in the area of \u200b\u200bthem. But if a clear sound is heard in one of the lungs, and a dull sound in the second, we are talking about an accumulation of purulent effusion.
The standing height of the pulmonary apices is also determined on both sides - behind and in front. The doctor stands in front of the patient, who must stand upright and be completely motionless. Then the doctor places the finger in the supraclavicular fossa, but always parallel to the clavicle. Begins to gently strike with the finger from top to bottom at a distance of 1 cm between each blow. But at the same time, the horizontal position of the finger must be preserved.
When a transition from a clear sound to a blunt one is detected, the doctor holds the finger in this place, after which he measures the distance from the median phalanx to the middle of the clavicular bone. In the absence of any deviations, this distance should be approximately 3-4 cm.
To determine the height of the apices 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 necessarily be horizontal. When finding the transition point from a clear to a dull sound, the doctor fixes it with his finger and asks the patient to lean forward in order to better see the seventh cervical vertebra. Normally, the upper border of the lungs should pass at this level.
Usually, pulmonary percussion requires moderate impacts, 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 turns to face 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 clavicle, a few cm above it.
- The clavicle is tapped with a finger.
- Then percussion is performed along the mid-clavicular lines in the area of \u200b\u200bthe first and second intercostal space. On the left side, percussion is not performed, since cardiac dullness interferes with the process. Heart sounds drown out the sound of the lungs when tapped.
- From the side, percussion is carried out along the axillary lines. In this case, the patient must raise his hands up and put them behind his head.
- To perform an examination in the back, the doctor stands behind the patient. In this case, the patient himself should slightly lean forward, lowering his head down and crossing his arms in front of his chest. Due to this position, the blades diverge to the side, so the space between them expands. First, the doctor begins to percut the area above the shoulder blades, and then gradually goes down.
If, instead of a clear sound, a dull sound is emitted, it is necessary to indicate the localization of this area in the patient's medical record. Dullness of sound may indicate that the lung tissue is compacted, so the airiness in the percussion zone is reduced. This condition speaks of pneumonia, tumors of the respiratory organ, tuberculosis and other diseases.
A dull sound is usually quieter, has a higher pitch, and is shorter in duration compared to a clear sound. In case of accumulation of fluid in the pleural cavity, the emitted sound resembles that obtained during percussion of the femoral muscles.
Percussion in children
Comparative lung percussion 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 kid should be in a comfortable position for him.
- The doctor must also be in a comfortable position to complete the procedure as quickly as possible.
- The doctor's hands should be warm and the nails cut off so as not to injure the child's skin.
- Strikes should be short and light.
- The results of the study must be recorded in the medical record.
Topographic percussion of the lungs in children is carried out according to the same rules. Unlike percussion in adults, the rate for children varies and depends on age.
Age table
Percussion is a very important procedure that is carried out for diagnostic purposes, as well as for the prevention of the development of certain diseases. In children under 10 years of age, the procedure is recommended to be carried out annually to monitor the development of the lungs... Then the check can be performed every 5-10 years for preventive purposes, and as needed for diagnostic purposes.
There are two types of lung percussion: topographic and comparative.
Topographic lung percussion
Topographic percussion of the lungs includes topography of the apex of the lungs, topography of the inferior margin of the lungs and determination of the mobility of the lower pulmonary margin, as well as topography of the lung lobes.
In front, percussion is carried out from the middle of the clavicle upwards and medially towards the mastoid process. Normally, the apex of the lung is 3 to 5 cm above the clavicle. In the presence of well-defined supraclavicular fossae, percussion along the nail phalanx. Behind determination of the border is carried out 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.
Determination of the width of the apexes of the lungs or Krönig fields is also of diagnostic value. They are defined from two sides, since it is important to assess 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 a tuberculous process with the development of fibrosis, the value of the Krönig field decreases on the side of the lesion, and in case of emphysema, it increases on both sides. The norms for the lower lung limit are shown in Table 3.
Table 3
Lower Lung Standards
|
Topographic lines |
On right |
Left |
|
By midclavicular |
Not determined |
|
|
On the anterior axillary | ||
|
Middle axillary | ||
|
On the back axillary | ||
|
Scapular | ||
|
By the paravertebral |
11 rib (or spinous process of the XI thoracic vertebra) |
|
In pronounced hypersthenics, the lower edge may be one rib higher, and in asthenics, one rib lower.
The mobility of the lower pulmonary margin is determined by the method of percussion along each topographic line, always on inhalation and exhalation. At the beginning, the lower border of the lung is determined with calm, breathing, then they ask the patient to take a deep breath and, while holding the breath, percussion further until the percussion sound becomes dull. Then they ask the patient to exhale completely and also percussion 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 margin. On 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 symmetry. Asymmetry is observed in unilateral inflammatory processes (pneumonia, pleurisy, in the presence of adhesions), and bilateral decrease is characteristic of pulmonary emphysema,
Comparative lung percussion
Comparative lung percussion is performed sequentially along the anterior, lateral and posterior surfaces of the lungs. When performing comparative percussion, the following conditions should be observed:
a) perform percussion in strictly symmetrical areas;
b) observe the identity of the conditions, meaning the position of the finger-pessimeter, pressure on the chest wall and the force of percussion strikes. Percussion of medium strength is usually used, but when identifying a focus located in the depths of the lung, they use strong percussion blows.
In front, percussion begins with the supraclavicular fossae, while the pessimeter finger is parallel to the clavicle. Then the clavicle itself and the area of \u200b\u200bthe 1st and 2nd intercostal space are percussed along the midclavicular lines, while the plessimeter finger is located along the intercostal space.
On the lateral surfaces, comparative percussion is performed along the anterior, middle and posterior axillary lines, with the patient's arms raised. When percussion of the posterior surface of the lungs, the patient is offered to cross his arms on the chest, while the shoulder blades diverge and the interscapular space increases. First, the suprascapular space is percussed (the finger-pessimeter is placed parallel to the spine of the scapula). Then the interscapular space is sequentially percussed (the finger-pessimeter is placed parallel to the spine). In the subscapularis, percussion is performed first paravertebrally, and then along the scapular lines, placing the plessimeter finger parallel to the ribs.
Normally, with comparative percussion, clear lung sound, basically the same in the symmetrical areas of the chest, although it should be remembered that the percussion sound on the right is determined 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 suppress the sound.
A dull or dull pulmonary sound is observed with a decrease in the airiness of the lung (infiltration of the lung tissue), accumulation of fluid in the pleural cavity, with a collapse of the lung (atelectasis), in the presence of a cavity filled with liquid contents in the lung.
Tympanic percussion sound is determined with an increase in the airiness of the lung tissue (acute and chronic emphysema), which is observed in various cavity formations: a cavity, an abscess, as well as air accumulation 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 (croupous) pneumonia (tide stage and resolution stage), in the area of \u200b\u200bthe Skoda strip with exudative pleurisy, with obstructive atelectasis.
Determining the boundaries of the lungs is of great importance for the diagnosis of many pathological conditions. The ability to detect percussion displacement of the chest organs in one direction or another allows already at the stage of examining the patient without the use of additional research methods (in particular, X-ray) to suspect the presence of a certain disease.
How to measure lung boundaries?
Of course, you can use instrumental diagnostic methods, take an X-ray and evaluate how the lungs are located relative to the bony frame of the chest. However, it is best to do this without exposing the patient to radiation.
Determination of the boundaries of the lungs at the stage of examination is carried out by the method of topographic percussion. What it is? Percussion is a study based on the identification of sounds that occur when tapping on the surface of the human body. The sound changes depending on which area is being explored. Over the parenchymal organs (liver) or muscles, it turns out to be deaf, over the hollow organs (intestines) - tympanic, and over the lungs filled with air it acquires a special sound (pulmonary percussion sound).
This study is carried out as follows. One hand is placed with the palm on the study area, two or one fingers of the second hand strike the middle finger of the first (pessimeter), like a hammer on an anvil. As a result, you can hear one of the percussion sound options mentioned above. Percussion is comparative (sound is assessed in symmetrical areas of the chest) and topographic. The latter is just intended to determine the boundaries of the lungs.
How to carry out topographic percussion correctly?
The finger-plessimeter is set 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 this measurement should approximately end. The limit is defined in the area where the pulmonary percussion sound becomes dull.
For the convenience of research, the finger plessimeter should lie parallel to the desired boundary. The offset step is approximately 1 cm. Topographic percussion, in contrast to comparative percussion, is performed by gentle (quiet) tapping.
Upper limit
The position of the apex 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 located normally as follows:
Research should be done like this:
Displacement of the upper boundaries of the lungs
The upward displacement 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 (bulls). Changes in the lungs with emphysema are irreversible, the alveoli swell, the ability to subside, the elasticity is lost, and sharply decreases. The boundaries of the human lungs (in this case, the apex limits) can shift downward. 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 of connective tissue and shrinkage of the lung). The boundaries of the lungs (upper), located below the normal level, are a diagnostic sign of 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 hands of the researcher with 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.
Anteriorly, the lower borders of the lungs are determined along a line running along the lateral surface of the sternum, as well as along a line descending from the middle of the clavicle. On the side, important landmarks are the three axillary lines - anterior, middle and posterior, which start from the anterior edge, center and posterior edge of the axillary cavity, respectively. Behind, the edge of the lungs is defined in relation 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 respiration, the volume of this organ changes. Therefore, the lower boundaries of the lungs are normally displaced 20-40 mm up and down. A persistent change in the position of the border indicates a pathological process in the chest or abdominal cavity.
The lungs become excessively enlarged with emphysema, which leads to a bilateral downward displacement of the borders. Hypotension of the diaphragm and pronounced prolapse of the abdominal organs can be other reasons. The lower border shifts downward 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.
Upward, the boundaries of the lungs move usually due to the wrinkling of the latter (pneumosclerosis), the collapse of the lobe as a result of bronchial obstruction, the accumulation of exudate in the pleural cavity (as a result of which the lung collapses and shrinks to the root). Pathological conditions in the abdominal cavity are also capable of displacing the pulmonary borders upward: for example, the accumulation of fluid (ascites) or air (with perforation of a hollow organ).
The boundaries of the lungs are normal: table
Lower bounds in an adult
Field of study
Right lung
Left lung
Line at the lateral surface of the sternum
5 intercostal space
-
A line descending from the middle of the clavicle
6 rib
-
Line originating from the front edge of the armpit
7 rib
7 rib
Line 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 to the side of the spine
11 thoracic vertebra
11 thoracic vertebra
The location of the upper pulmonary borders is described above.
Change in indicator depending on physique
In asthenics, the lungs are elongated in the longitudinal direction, so they often fall slightly below the generally accepted norm, ending not on the ribs, but in the intercostal spaces. For hypersthenics, on the contrary, a higher position of the lower border is characteristic. Their lungs are wide, flattened in shape.
How are the pulmonary borders located in a child?
Strictly speaking, the boundaries of the lungs in children practically correspond to those in an adult. The tops of this organ in guys who have not yet reached preschool age, which are not determined. Later, they appear in the front 20-40 mm above the middle of the clavicle, behind - at the level of the seventh cervical vertebra.
The location of the lower boundaries is discussed in the table below.
Lung boundaries (table)
Field of study
Age up to 10 years
Age over 10 years
Line from the middle of the clavicle
Right: 6 rib
Right: 6 rib
The line originating 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
The reasons for the displacement of the pulmonary borders in children up or down relative to normal values \u200b\u200bare the same as in adults.
How to determine the mobility of the lower edge of an organ?
It was already mentioned above that during breathing, the lower boundaries shift relative to normal values \u200b\u200bdue to the expansion of the lungs on inspiration and a decrease on expiration. 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 in three main lines, starting from the middle of the clavicle, the center of the armpit and the angle of the scapula. Research is carried out as follows. First, the position of the lower border is determined and a mark is made on the skin (you can use a pen). Then the patient is 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, the position of the lung is determined at maximum exhalation. Now, focusing on the estimates, one can judge how the lung is displaced along its lower boundary. In some diseases, the mobility of the lungs is markedly reduced. For example, this occurs with adhesions or a large amount of exudate in the pleural cavities, loss of elasticity in the lungs in emphysema, etc.
Difficulty conducting topographic percussion
This research method is not easy and requires certain skills, or better, also experience. Complications arising from its use are usually associated with incorrect execution technique. As for the anatomical features that can create problems for the researcher, it is mainly expressed obesity. In general, percussion is easiest to perform on asthenics. The sound is clear and loud.
What needs to be done to easily define the boundaries of the lung?
And, of course, experience is very important. Practice builds self-confidence.
Summarize
Percussion is a very important diagnostic method of research. It allows one to suspect many pathological conditions of the chest organs. Deviations of the boundaries of the lungs from normal indicators, impaired mobility of the lower edge are symptoms of some serious diseases, the timely diagnosis of which is important for full treatment.
Topographic percussion of the lungs is a physical diagnostic method based on tapping the chest and assessing the sounds that occur during the procedure. By the nature of sound vibrations, the physical condition, size, and location of the respiratory system are determined.
Methods for measuring the border of the lungs
Topographic percussion allows you to determine the position of the lungs in the chest relative to adjacent internal organs. This can be achieved due to the difference between the sounds that occur when tapping air lung tissue and denser, air-free structures. The study includes consistent clarification of the height of the apices, the width of the fields, the lower boundaries and the mobility of the lobar margins.
Lung topography is performed using several percussion methods:
- deep;
- superficial.
The method of deep tapping allows you to identify the parameters of the organ, pathological seals, respiratory sounds, neoplasms located deep in the parenchyma. The superficial diagnostic method helps to distinguish between air-containing and airless tissues, to determine the localization of pathological foci and cavities.
Percussion rules
The diagnostic procedure is performed by a pulmonologist according to the following rules:
- topographic percussion is performed in the direction from a clear pulmonary sound to a deaf one;
- the doctor places a finger-plessimeter parallel to the supposed edge of the lungs;
- the limit line corresponds to the outer edge of the finger from the side of the internal organ, which gives a clear percussion sound;
- shallow percussion is used first, followed by deep percussion.
Topographic lung percussion is performed 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 applies a finger-pessimeter to the body tightly, but does not allow the phalanx to sink too deep into the soft tissues, so as not to provoke an increase in sound vibration.
Upper bounds
To localize the height of the pulmonary apices, the plessimeter is placed in the supraclavicular fossa parallel to the clavicular bone. A few blows are applied with a hammer finger, then the pessimeter is raised so that the nail rests on 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 measuring tape or ruler, measure the gap from the middle of the collarbone to the tips identified during the examination.
Reasons for displacement of the upper boundaries
The tops are raised above the norm with emphysema, bronchial asthma, and lowered when sclerosing the respiratory organ, for example, with tuberculosis, the formation of foci of infiltration. The downward displacement of the tops is observed with a decrease in airiness, pneumonia, pneumosclerosis.
Determination of the parameters of the lower boundaries begins with tapping the right lung along the parasternal (parasternal) line.
For diagnostics, the topographic lines of the chest are examined: mamillary (mid-clavicular), scapular - under the angulus inferior, axillary, located at the height of the axillary cavity, 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 peristernal and mid-clavicular lines. This is due to the proximity of the heart, the influence of the gas gastric bladder on the dullness of sound. When performing topographic percussion from the front, the upper limbs of the patient are lowered down, when tapping the axillary region, they are raised above the head.
Descent of the lower edges can be a symptom of a low standing of the diaphragm, emphysema. Elevation is noted with wrinkling, scarring of the lung tissue against the background of croupous 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. The displacement of the lower edges also occurs with cancerous tumors, a sharp increase in the size of the liver.
Normal location of the borders of the lungs
In a healthy person, the height of the apices on the front side of the body is fixed 3-4 cm above the clavicular bone, and behind it corresponds to the level of the transverse spinous process of the seventh cervical vertebra - C7.
Normal indicators of the lower limits:
Measurement of the indicator taking into account the characteristics of the physique
In hypersthenics with a large chest, a long torso, it is allowed to raise the lower edges of the lungs by one costal arch, and in asthenics, the lower edge is observed to drop one rib below the physiological norm.
