Percussion

Question 1

What is Traube’s space?

Answer 1

Traube’s space is a (roughly) quadrilateral area on the left lower chest. It is normally resonant due to the underlying gastric fundus, and loses its resonance in certain conditions.

Question 2

Importance of Traube’s space

Answer 2

Traube described his space for help with the diagnosis of pleural effusion.
Normally due to stomach bubble percussion in Traube’s space is very resonant.

Causes of obliteration of Traubes space:

1. Full stomach.
2. Left sided Pleural effusion. 3.Splenomegaly.
3. Enlargment of left lobe of liver due to any etiology.
4. Dextrocardia.
5. Proloiferative growth in fundus of stomach.

In a lung collapse, the lung retracts, and Traube’s space will enlarge.

Question 3

Boundaries of Traube’s Space

Contents

Answer 3

1. Right : Lateral margin of left lobe of liver. 2. Left : Spleen.
2. Superior : Resonance of lung.
3. Inferior : Costal margin.

Contents

1. Fundus of stomach (Hence percussion of Traubes area normally gives Tympanitic resonance).
2. Costo-phrenic recess of left pleura devoid of lungs.

Question 4

Sounds associated with the liver

Answer 4

Above- Lung resonance
Below- Tympanic
Over the liver- dullness

Question 5

What different sounds can we percuss?

Answer 5

Hyper-resonance
Resonance- lungs 
Dullness- over solid organs
Flatness- over heavy muscles or bone
Tympany- over intestines

Question 6

Where to percuss the spleen

Answer 6

Post midaxillary line
Dull tone over spleen 9th-11th ribs
(Compare with resonant tone of 9th ICS i axillary line)

Question 7

Percussed sounds in the abdomen

Answer 7

Dullness on R and L upper quadrants- liver and spleen
Dullness over supra pubic area distended bladder/ large uterus
Tympanic sounds for intestine

Question 8

What structure causes dullness behind the right breast?

Answer 8

Right middle lobe of Lung (with pneumonia)

Question 9

What happens to percussion note and tactile fremitus in lobar Pneumonia?

Answer 9

Percussion note-dull over consolidated lung tissue

Tactile Fremitus- Increased

Question 10

What happens to percussion notes and tactile fremitus in PTX

Answer 10

Percussion note- Hyper-resonant or tympanic

Tactile Fremitus- decreased or absent

Question 11

What happens to percussion notes and tactile fremitus in Pleural effusion?

Answer 11

Percussion note- Dull over fluid

Tactile Fremitus- Decreased

Question 12

Diaphragmatic Excursion

Answer 12

Movement of diaphragm during breathing

Normally 3-5 cm bilaterally

Question 13

How do we percuss the lungs?

Percussion notes of the lungs

Answer 13

Percuss from Apex–> Base
Compare percussion notes of both sides at same intercostal level

Normal lung fields are resonant on percussion (intensity loud, pitch low, duration long)
Dullness on percussion- consolidation due to pneumonia or fluid
Hyper-resonance- excess air (PTX)
Diffuse hyper-resonance seen in emphysema

Question 14

Abnormal heart sounds heard on percussion

Answer 14

Expanded area of dullness may suggest cardiomegaly or pericardial effusion

Question 15

Abnormal percussion sounds in the abdomen

Answer 15

Shifting dullness–ascites

Non-motile dullness– intra abdominal tumours or masses

Question 16

Abnormal percussion sounds in the lungs

Answer 16

Dullness due to pneumonia, tumor, infarction, or fluid collection;
hyperresonance or even tympany due to air collection, as seen in pneumothorax or emphysema