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Topographic percussion of the lungs

Determining the borders of the lungs is started from the lower border of the right lung (pulmonohepatic border), percussion is done from the top (beginning with the subclavicular area) downward along the parasternal, medioclavicular, axillary, scapular and paravertebral lines.

The position of the lower border of the lung is determined in the following way (Fig. 15): the plessimeter finger is applied to the second intercostal space parallel to the probable border. Weak taps are made moving the plessimeter finger downward from one intercostal space to another until a clear sound changes into a dull one. The place of transition of a clear sound to a dull one is marked on the skin using a special pencil. Having determined the location of the lower border of the lung on all lines (beginning from the parasternal line) and marked this area, the points are joined by a line. This line is the projection of the lower border of the lung on the chest wall. After having determined the lower edge of the lung on the lateral surface of the chest wall (between the anterior and posterior axillary lines), the patient should be asked to put the respective hand on the head. The lower border of the left lung is determined in the same way, beginning the percussion from the anterior axillary line (cardiac dullness, the cardiac notch, is located medially). Along the axillary and the other lines the lower border is determined in the same manner as on the right side.

 

Place of percussion Right lung Left lung
Along the parasternal line 5th intercostal space
Along the medioclavicular line 6th intercostal space
along the anterior axillary line 7th intercostal space 7th intercostal space
along the median axillary line 8th intercostal space 8th intercostal space
along the posterior axillary line 9th intercostal space 9th intercostal space
along the scapular line 10th intercostal space 10th intercostal space
along the paravertebral line The process of the lit The thoracic vertebra

Determining the upper border of the lungs The upper border of the lung is determined using percussion of the lung apices over the collarbone and the spine of scapula (spina scapulae). The percussion is started from the middle of the supraclavicular fossa going upwards (silent percussion, the plessimeter finger is parallel to the studied border). On the back, the percussion is done from the middle of the fossa supraapinata to the process of the 7th cervical rib. With this method, the apex is 35 cm above the collarbone, and at the level of the 7th cervical vertebra on the back. Determining Kronig's fields is also used. The Kronig's field is a 5-cm band of a clear percussion sound going through the shoulder from the clavicle to the spine of scapula divided by the edge of the trapezius muscle into the anterior and posterior portions. The percussion is started from the middle of the space going downwards and upwards until dullness is heard, this is the way to find out external and internal borders of this field as well as its width. In a healthy person the width of Kronig's fields is about 56 cm (ranging from 3,5 to 8 cm).



Determining the lung border mobility Topographic percussion of the lungs is used to define the degree of the lung border mobility. This can be active and passive. Active mobility is that to change the position depending on the phase of respiration. Passive mobility is that of the borders to shift depending on the changes in the position of the body.

The volume of the lung border expiratory excursion is the distance between the positions of the lung border at maximally deep breathing in and out. On the right side, it is determined along three lines: medioclavicular, median axillary, scapular, on the left side along two lines: median axillary and scapular and is due to elastic expanding and contracting of the lugs as well as the depth of the pleural sinus, to which the border of the lung enters at respiratory expansion of the lung. The lower border of the lung has the greatest respiratory mobility along the median axillary line. On deep breathing, the lower border of the lung goes down 4 cm lower than on normal breathing. Thus, at the level of median axillary line the respiratory excursion of the lower border of the lung is 8 cm. At the level of medioclavicular line it equals 4 cm.

Mobility of the lower border of the lungs is determined in the following way: first, the position of the lower border of the lung on medium breathing is determined using percussion and marked with a pencil. Then the patient is asked to take a deep breath and hold his breath. The position of the border is determined once again and marked with the pencil. Then the patient breathes out maximally and holds his breath. Percussion is done upwards until a clear lung sound appears and the third mark is made on the borderline of the relative dullness. The distance between the second and third marks in centimeters is the respiratory excursion of the lung border.

The position of the lower border of the lungs may change because of a number of causes: pathology of the lungs, diaphragm, pleura, abdominal organs. The lower border of the lungs may shift downward or upward the normal position, these changes can be both unilateral and bilateral. The lower border can shift down in acute (an attack of bronchial asthma) or chronic (pulmonary emphysema) expansion of the lungs as well as in pronounced weakening of the tone of the abdominal muscles (splanchnoptosis).

Upward displacement of the lower border of the lungs is usually unilateral and accompanies pneumosclerosis, obturation atelectasis, accumulation of fluid or air in the pleural cavity, significant enlargement of the liver (cancer, echinococcus), enlargement of the spleen.

Bilateral displacement of the lower border is observed when intra-abdominal pressure is increased, i.e. accumulation of fluid (ascites), air (due to acute perforated ulcer) in the abdominal cavity, pronounced flatulence, obesity.

Reduced mobility of the lower border is present in pulmonary emphysema (reduction of the lung elasticity), inflammatory infiltration of the lungs, presence of large amount of fluid in the pleural cavity, in pleural obliteration.

Materials for self-control(added)

 

Reference source

 

o Olga Kovalyova, Tetyana Ashcheulova Propedeutics to internal medicine, Part 1. Vinnytsya: NOVA KNYHA, 2006. p. 62-68, 89-103.

 

Professor assistant Demchuk H.V.



Date: 2015-12-18; view: 4349


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