Physical Signs In Lung Diseases

1)LARGE PLEURAL EFFUSION
Chest wall movement- decreased on affected side
Mediastinum and trachea shift to opposite side
Absent tactile vocal fremitus
Percussion- stony dull
Breath sounds – absent, maybe bronchial (+/- whispering pectoriloquy) above fluid level
Pleural rub maybe heard above fluid

2)CONSOLIDATION (eg: pneumonia)
Chest wall movement decreased on affected site
No mediastinal or tracheal shift
Tactile vocal fremitus increased
Percussion- dull
Breath sound- bronchial
Added sounds- fien or medium crepitations

3)MASSIVE COLLAPSE
Signs of decreased lung volume
i)supraclavicular hallowing
ii)infraclavicular flattening
iii)drooping of shoulder
iv)rib crowding
Chest wall movement- decreased on affected side
Mediastinum and trachea shift toaffected side
Focal fremitus- absent
Percussion- dull
Breath sound- decreased
Added sound- absent

4)FIBROSIS
Chest wall movement- local flattening with decreased movement
Mediastinum and trachea shift to affected side
Vocal fremitus- increased
Percussion- dull
Breath sound- bronchial
Added sound – maybe coarse crepitations



5)LARGE PNEUMOTHORAX
Chest wall movement decreased on affected side
Mediastinum and trachea shift to affected side
Vocal fremitus- decreased
Percussion- hyperresonant
Breath sound- decreased
Absent added sound

6)BRONCHITIS
Chest wall movement – decreased bilaterally
No shifting of mediastinum or trachea
Vocal fremitus- normal or decreased
Percussion- hyperresonant
Breath sound- decreased
Added sound- rhonchi and crepitations

7)EMPHYSEMA
Chest wall movement decreased bilaterally
Central mediastinum and trachea
Vocal fremitus decreased
Percussion- hyperresonant
Breath sound- decreased
Added sound- absent