Lung Examination: Abnormal

Lung Examination: Abnormal
By:Arcot J. Chandrasekhar, M.D.

Illustrative Pathological problems
* Consolidation
* Atelectasis
* Pleural effusion
* Pneumothorax
* Mass
* Diffuse lung disease

Steps
* General Examination
* Mediastinal position
* Chest expansion
* Lung resonance
* Breath sounds
* Adventitious sounds
* Voice transmission
* Respiratory rate
* Pattern of breathing
* Cyanosis
* Clubbing
* Weight
* Cough
* Hospital setting
* Effort of ventilation
* Shape of thorax

Respiratory Rate
* Bradypnea: rate less than 8 per minute
* Tachypnea: rate greater than 25 per minute

Pattern of Breathing
* Kussmals
* Sleep apnea
* Cheyne strokes
* Pursed lip breathing
* Orthopnoea: Short of breath in supine position, gets some relief by sitting or standing up.

Sleep apnea syndrome
Central Cyanosis
Corpulmonale
Clubbing
Significance: Clubbing Observed In:
* Intrathoracic malignancy: Primary or secondary (lung, pleural, mediastinal)
* Suppurative lung disease: (lung abscess, bronchiectasis, empyema)
* Diffuse interstitial fibrosis: Alveolar capillary block syndrome
* In association with other systemic disorders
Effort of Ventilation
* Person appears uncomfortable. Breathing seems voluntary.
* Accessory muscles are in use, expiratory muscles are active and expiration is not passive any more.
* The degree of negative pleural pressure is high.
* The respiratory rate is increased.

Resting Size and Shape of Thorax
* Barrel chest
* Kyphosis
* Scoliosis
* Pectus excavatum
* Gibbus
Barrel Chest
AP Diameter = Transverse Diameter
Tracheal Position: Mediastinum
Chest Expansion
Percussion: Decreased or Increased Resonance is Abnormal
* Dullness
* Hyper resonance
* Traube's space

Breath Sounds: Diminished or Absent
* Intensity of breath sounds, in general, is a good index of ventilation of the underlying lung.
* Breath sounds are markedly decreased in emphysema.
* Symmetry: If there is asymmetry in intensity, the side where there is decreased intensity is abnormal.
* Any form of pleural or pulmonary disease can give rise to decreased intensity.
* Harsh or increased: If the intensity increases there is more ventilation and vice versa.
* Bronchial breathing anywhere other than over the trachea, right clavicle or right inter-scapular space is abnormal.
* In consolidation, the bronchial breathing is low pitched and sticky and is termed tubular type of bronchial breathing.
* In cavitary disease, it is high pitched and hollow and is called cavernous breathing. You can simulate this sound by blowing over an empty coke bottle.

Bronchial breathing
Rhonchi
Pleural Rub
Crackles
Voice Transmission (tactile fremitus, vocal resonance)
* Asymmetrical voice transmission points to disease on one side.
* Increased:
* Decreased
* Qualitative alteration:
Voice Transmission
Bronchophony
Whispering Pectoroliquy
Normal whisper
Egophony

Lung Examination: Abnormal.ppt