Lung percussion is the main method of clinical examination

Lung percussion, along with auscultation, is considered the most important method of clinical examination of patients with respiratory diseases. Percussion is still widely used in clinical practice, despite the emergence of new diagnostic methods of instrumental research.

The method of percussion or percussion was proposed by the Austrian physician Auenbrugger in 1761, and in clinical practice was introduced by the French physician Corvisar. Percussion of the lungs, like other organs, is carried out by hands, does not require the use of additional instruments, simple and highly informative.

The method is based on the fact that the internal organs give different heights when tapping. The quality of these sounds, called percussion, depends on the content and density of the tissues of the organs. During percussion of body parts that do not contain air, a deaf percussion sound is formed. A similar sound is formed, for example, with percussion of the liver. With percussion of organs containing a lot of air, the sound is sonorous. Thus, by changing the percussion tone, it is possible to judge changes in internal organs, their location.

Normally, over the whole surface of the lungs, due to the high air content, a sonorous sound is determined. This sound is called clear pulmonary. With the development of various diseases, the air content in the lungs may increase or decrease, and percussion sound also changes.

Changes in percussion sound occur in the direction of blunting or in the direction of tympanitis, that is, increased voicing. The nature of the sound depends on the amount of air and the density of the underlying tissues.

Dullness of percussion sound occurs when collecting exudate in the pleural cavity, reducing the amount of air in the lung tissue due to pneumosclerosis, with the development of inflammation of various origin, tumor growth.

The increase in voicing during percussion is observed when there is an accumulation of excess air in the lungs, which happens with emphysema or bronchial asthma. A high percussion sound is determined over large cavities in the lungs filled with air (tuberculous caverns, open lung abscess , pneumothorax).

Topographic percussion of the lungs is used, first of all, to determine the boundaries of the lungs. First determine the boundaries of the tips of the lungs. Normally, the height of the apex location is determined above both clavicles by 3-5 cm. Then they find the lower border starting from the right half. With the expansion of the lungs, their lower limit is lowered, and when the diaphragm is high, it is during pregnancy, ascites, meteorism, on the contrary, rises. Topographic percussion of the lungs makes it possible to determine the respiratory excursion of the lungs, that is, their active mobility, which is the difference between the lower border of the lungs during maximum inhalation and exhalation. In healthy people, a lung excursion is 4-8 cm. In severe inflammatory processes in the lungs, emphysema, pleurisy, pneumosclerosis, a lung excursion is reduced. This is due to a decrease in elasticity and the ability of the lung tissue to decompress during inspiration.

Comparative lung percussion is successfully used to diagnose pathological processes in any part of these organs. In this case, the percussion tone is compared with the normal tone in the symmetrical regions. In healthy people, it is the same in the right and left halves of the chest.

Thus, percussion of the lungs, carried out in conjunction with other basic methods of clinical examination of the patient, allows you to quickly identify changes in lung tissue and put a preliminary diagnosis of the disease.