Repeat the percussion at four and five levels, comparing each lung level side by side, working up to the chest wall, starting at the inferior lung borders.The sound should be hollow, representing an air-filled lung. Use the tip of the middle finger (plexor finger) of the dominant hand to tap firmly on the top third (middle or distal phalanx) of the pleximeter finger of the non-dominant hand at least twice (it is advisable to keep fingernails short).Make sure the other fingers and palm are not pressed against the patient's chest.The firmer the finger is pressed to the chest wall, the louder the percussion note tends to be. Place non-dominant hand with middle finger (pleximeter finger) pressed and hyperextended firmly on the patient's right or left mid-back area (lower levels of lungs posteriorly).Percuss both posteriorly and anteriorly, starting on the back.Examining the posterior of the lung requires the patient to be leaning forward or sitting on the edge of the bed. Position the patient on the examination table at a 30- to 45-degree angle and approach from the right side.Make sure the patient is undressed down to the waist.RUL - right upper lobe RML - right middle lobe RLL - right lower lobe LUL - left upper lobe LLL - left lower lobe. An approximate projection of lungs and their fissures and lobes to the chest wall anteriorly. Anatomy of lungs with respect to the chest wall. The superior lobe of the left lung also has a separate projection known as the lingual.įigure 1. The left lung has two lobes: the superior and inferior lobes. The right lung has three lobes: the superior, middle, and inferior lobes. Each lung lobe can be pictured underneath the chest wall during percussion and auscultation ( Figure 1). The areas for auscultating the lungs correspond to the lung zones. Auscultation can provide an almost immediate diagnosis for a number of acute pulmonary conditions, including chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and pneumothorax. Percussion is a useful skill that is often skipped during everyday clinical practice, but if performed correctly, it can help the physician to identify underlying lung pathology.
Learning the proper technique for percussion and auscultation of the respiratory system is vital and comes with practice on real patients. Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
