TIDAL PERCUSSIONTo distinguish whether the cause of dullness over the lower part of the chest is due to

– upward enlargement of liver or spleen, or – intra thoracic pathology.

Method :

Patient will sit with hands crossed over the knees or shoulders.

Percuss the lower part of the chest, along the scapular line, to mark the level of dullness twice

at the end of deep inspiration again, at the end of deep expiration.

Clinical Importance :

Normally, there would be a difference in resonance by one space in full inspiration, due to the downward movement of diaphragm.

Paradoxical resonance - dull note on inspiration and resonant note on expiration, due to paradoxical movement of in diaphragmatic palsy.

Dullness which does not change on inspiration or expiration – intra thoracic causes i.e. basal pneumonia or basal pleurisy.

Dullness which goes down with inspiration – sub diaphragmatic causes i.e. amoebic liver abscess.

TRAUBE’S SPACEA crescent shaped space encompassed by lower border of left lung, anterior border of spleen, left costal margin and inferior margin of left lobe of liver.

Borders :

Superiorly : Left dome of diaphragm and left lung i.e. the 6th rib

Laterally : Left mid axillary line

Inferiorly : Left lower costal margin

Method :

Patient lies supine with the left arm abducted.

During normal breathing, the space is percussed from medial to lateral margins, i.e. from xiphisternum to the left mid axillary line across 6th and 7th intercostal space (Barkun’s method).

Clinical Importance :

Normally, the space is tympanitic on percussion as it contains the fundus of the stomach.

Tympanicity is lost in :

- Carcinoma involving the fundus or full stomach

- Left sided pleural effusion

- Enlarged left lobe of liver

- Massively enlarged spleen or ruptured spleen.

KRONIG’S ISTHMUS A band of resonance of 5 - 6 cm width in the apex of the lung.

It connects the lung resonance on the anterior and posterior chest on each side.

Borders :

– Medially : the neck muscles

– Laterally : the ipsilateral shoulder joint

– Anteriorly : the clavicle

– Posteriorly : the trapezius muscle.

Method :

Percuss over the apex of the lung, from the back of the patient.

Pleximeter finger should be placed over the supraclavicular fossa, across the anterior border of trapezius, perpendicular to the clavicle.

Clinical importance :

Normally the note is resonant.

Area becomes dull in :– Apical tuberculosis, Pancoast’s tumour, Apical pneumonia.