Percussion findings

Medicine 4
Trivia
It was initially used by Joseph Leopold who
noticed that tapping of the wine barrels in his
father’s cellar provided a rough way to determine
their contents- if they were full or not.
Sounds heard in percussion

• resonant
• hyper-resonant
• stony dull
• dull
 Methods of percussion
-Direct Percussion
• Over bony structures such as sternum.

-Indirect Percussion
• percussion of aortic and pulmonary areas
• plexor and pleximeter method

-Auscultatory Percussion
• to determine cardiac borders
• Done using a stethoscope and fingers
Direct percussion over sternum

-patient in supine position

Normal resonant note
Normal dull note

Area of sternum Dull note

Manubrium sterni ● Aortic aneurysm

● Mediastinal
pathology (especially
tumor)

Lower part of sternum ● RV hypertrophy or

● Pericardial effusion
https://link.springer.com/chapter/10.1007/978-981-13-7677-1_45
Indirect percussion - Aortic/pulmonary area
s
Area Normal Abnormal

Aortic area(2nd Resonant ● Aortic

right ICS) aneurysm/dilated
ascending aorta
● Superior
mediastinal tumor
or
● Pericardial
effusion.

Pulmonary Resonant ● Dilated

area(2nd left ICS) pulmonary artery
● PDA or
● Sometimes,
enlarged LA
appendage
Ascultatory percussion

• (Similar to the scratch test in ascites)

• the stethoscope is placed over the
sternum just above the xiphisternum
• the skin is lightly scratched inwards
from the axillae towards the sternum.
• The point at which the soft scratching
sound becomes suddenly intense
corresponds to the cardiac border on
that side
Conventional method percuss
ion of heart borders
Special percussions
Percussion findings in vari
ous pathological states
Pathological Area of percussion Normal Abnormal
state

Mitral stenosis

Mitral
regurgitation

Aortic stenosis

Aortic
regurgitation
Congenital heard disease- Acyanotic

Pathological Area of percussion Normal Abnormal

state

ASD

VSD

PDA

Pulmonary
stenosis
Congenital heard disease

cyanotic+increased blood flow

Cyanotic+decreased blood flow

Cardiomyopathy