Overview
This lecture reviews how to apply tactile fremitus and percussion exam findings to diagnose different lung conditions.
Percussion and Tactile Fremitus: Quick Review
- Tactile fremitus is the vibration felt on the chest during speech.
- Percussion assesses resonance or dullness by tapping on the chest wall.
- Increased fremitus means better sound transmission through the lung.
- Dullness to percussion suggests fluid or consolidation.
- Hyperresonance suggests extra air in the pleural space or lung.
Diagnostic Scenarios and Key Findings
Pneumonia
- Normal findings on the left lung.
- Right lung lower two-thirds: dullness to percussion, increased tactile fremitus.
- Consolidation (liquid in lung) causes increased fremitus and dullness.
Pneumothorax
- Left lung normal.
- Right lung lower two-thirds: hyperresonance to percussion, decreased tactile fremitus.
- Air in pleural space reduces fremitus and increases resonance.
Pleural Effusion
- Left lung normal.
- Right lung lower two-thirds: dullness to percussion, decreased tactile fremitus.
- Fluid outside the lung (in pleural space) decreases fremitus and causes dullness.
Chronic Obstructive Pulmonary Disease (COPD)
- Bilateral decreased breath sounds, decreased tactile fremitus, hyperresonance to percussion.
- Difficult to detect clinically if bilateral; findings are subtle unless compared over time.
Pulmonary Edema and Pulmonary Fibrosis
- Both present with bilateral diffuse crackles on exam.
- Pulmonary edema: volume overload signs (edema, elevated jugular venous pressure, third heart sound).
- Pulmonary fibrosis: finger/toe clubbing plus crackles.
Key Terms & Definitions
- Tactile fremitus — vibration felt on the chest wall during vocalization.
- Percussion — tapping on the chest to assess density of underlying tissue.
- Dullness — decreased resonance indicating fluid or solid tissue.
- Hyperresonance — increased resonance, usually from extra air.
- Consolidation — lung tissue filled with liquid (e.g., pneumonia).
- Pleural effusion — fluid in the pleural space around the lung.
Action Items / Next Steps
- Review differences in physical exam findings for each lung condition.
- Practice percussion and tactile fremitus techniques on peers.
- Prepare for clinical scenarios involving lung exam interpretation.