Respiratory System Examination : Inspection, Palpation, Percussion & Auscultation
Systemic examination of respiratory system is as following:
Upper respiratory tract
- Nose, nasal cavity
- Sinus (Frontal, ethmoidal, maxillary)
- Oropharynx
Lower respiratory tract
All the findings in the clinical examination should be compared on both sides in the following areas:
Anteriorly
- Supraclavicular area
- Infraclavicular area
- Mammary region
Laterally
- Axillary region
- Infra-axillary region
Posteriorly
- Suprascapular region
- Interscapular region
- Infrascapular region
A. Inspection
Chest
- Shape
- Symmetry (Look for lie of ribs, shoulder drooping, intercostal space, spine, flattening, hollowing, fullness, suprascapular fossa, spinoscapular distance)
- Movement: Rate, rhythm, equality and type of breathing
Position of mediastinum
- Trachea: Trail’s sign (Present or Absent)
- Apex beat: It is shifted to the side of mediastinal shift
B. Palpation
Confirmation for position of mediastinum
- Trachea: Confirmation of trail’s sign (Present or Absent). Slight shift of trachea to the right is normal.
- Confirmation of apex beat
Confirmation for respiratory movements
- Assessment of anterior thoracic movement
- Assessment of posterior thoracic movement
Assessing Symmetry of Chest Expansion
- Assessment of upper thoracic expansion
Measurement of the Chest Expansion
- Chest circumference (cm)
- During deep inspiration
Tenderness
- Intercostal spaces
- Ribs
Tactile vocal fremitus
Read: Medical History Taking : Chief Complaints & Suggestive Involved System
C. Percussion
The sitting posture is the best position of choice for percussion. Supine posture is not desirable because of the alteration of the percussion note by the underlying structure on which the patient liesa.
Percussion should be done both side (comparing each other) in following posture:
- Anterior percussion: The patient sits erect with the hands by his side
- Posterior percussion: The patient bends his head forwards and keeps his hands over the opposite shoulders. This position keeps the two scapulae further away so that more lung is available for percussion.
- Lateral percussion: The patient sits with his hands held over the head.
Anterior Chest Wall
- Clavicular
- Supraclavicular (Kronig’s isthumus)
- Infraclavicular
- 2nd to 6th intercostal spaces
Lateral Chest Wall
- Fourth to seventh intercostal spaces
Posterior Chest Wall
- Suprascapular (above the spine of the scapula)
- Interscapular region
- Infrascapular region up to the 11th rib
Right Side
- Liver dullness (Upper border)
- Tidal Percussion
Left Side
- Traube’s Space
- Cardiac dullness
D. Auscultation
Auscultatory areas are as following
- Anteriorly: From an area above the clavicle down to the 6th rib
- Axilla: Area upto the 8th rib
- Posteriorly: Above the level of the spine of the scapula down to the 11th rib
What to observe?
Type of breath sounds
- Vesicular
- Bronchial
- Vesicular with prolonged espiration
Absent Breath Sounds
Added Sounds
- Crackles
- Rhonchi
Pleural rub
Pleuro-pericardial rub
Voice Sounds
- Vocal resonance
Other foreign sounds
- Stridor
Special Tests (If required)
- Heimlich’s manoeuvre
- Post-tussive suction
- Succussion splash
- Coin test
- DeEspine’s sign
