Corpus: Chest percussion

Chest percussion is a physical examination technique used to assess the thorax by tapping on the back of the chest with the fingers. The sound produced helps determine the size and extent of the lungs and detect any pathological changes in the lungs or pleural cavity.

Chest percussion is part of the physical examination, along with inspection, auscultation, and palpation of the chest.

The examination is performed with the patient in a sitting position, with the upper body exposed. Indirect percussion (finger-finger technique) is used: the examiner places the non-dominant hand flat on the patient’s upper back and taps on one finger using the middle finger of the dominant hand, applying movement from the wrist. The entire back of the thorax is percussed from top to bottom.

The lower lung borders are then assessed for respiratory movement. This is done by identifying the transition from the resonant lung sound to the dull sound of underlying organs first at the end of expiration and then at maximum inspiration. The patient must be given clear instructions for this part of the examination.

Percussion should always be performed by comparing both sides of the chest.

3.1. Normal findings

A normal percussion sound over the lungs is resonant on both sides. The transition from the resonant lung sound to a dull sound occurs approximately at the level of the 12th thoracic vertebra. The right lung border is typically about 1 cm higher than the left due to the position of the liver. A symmetrical movement of the lung borders during breathing, with a displacement of about 5 to 6 cm (approximately 2 to 3 finger widths), is considered normal.

3.2. Pathological findings

A dull (hyposonorous) percussion sound over the lungs suggests fluid accumulation, such as in pleural effusion or pneumonia with inflammatory exudate. Solid lung masses, such as bronchial carcinoma, can also cause a dull sound if they are located within 5 cm of the chest wall.

A hyperresonant (loud and hollow) percussion sound indicates increased air content in the lungs or chest cavity. This is seen in obstructive lung diseases such as emphysema, asthma, and COPD, as well as in pneumothorax.

A tympanic (drum-like) percussion sound may result from underlying distended stomach or intestinal loops.

Reduced or absent movement of the lung borders during breathing may be seen in conditions such as pulmonary fibrosis or emphysema. Asymmetrical lung borders can indicate malignant processes, lung collapse (atelectasis), or abnormal diaphragm positioning.

• Pjontek et al: Heidelberg Standard Examination, 2nd edition, HeiCuMed, 2013
• Gahl et al: Auscultation and percussion, Thieme Verlag, 2009