Percussion of the lungs, 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 proposedAustrian physician Auenbrugger in 1761, and in clinical practice was introduced by the French doctor Corvizar. 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 internal organspercussions give different heights in sounds. 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 and their location.
Normally above the whole surface of the lungs due toa large amount of air is determined by a sonorous sound. 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, an increase in voicing. The nature of sound depends on the amount of air and the density of the underlying tissues.
Dullness of percussion sound happens atcollecting exudate in the pleural cavity, reducing the amount of air in the lung tissue due to pneumosclerosis, with the development of inflammation of various origins, tumor growth.
Increased voiced during percussion observedwith accumulation in the lungs of excess air, which happens with emphysema or bronchial asthma. High percussion sound is determined over large cavities in the lungs filled with air (tuberculous caverns, opened lung abscess, pneumothorax).
Topographic percussion of the lungs is applied,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 a respiratory lung excursion, that is, their active mobility, which is the difference between the lower border of the lungs during maximum inspiration and expiration. In healthy people, a lung excursion is 4-8 cm. In severe inflammatory processes in the lungs, emphysema, pleurisy, pneumosclerosis, a lung excursion decreases. This is due to a decrease in elasticity and the ability of the lung tissue to decompress during inspiration.
Comparative lung percussion was successfulIt is used to diagnose pathological processes in any part of these organs. In this case, the percussion tone is compared with the normal tone in symmetrical areas. In healthy people, it is the same in the right and left halves of the chest.
Thus, percussion of the lungs, conducted incomplex 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.
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