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Pulmonary Examination

  • Author: Joseph Z Springer, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
 
Updated: Jan 08, 2016
 

Background

A thorough pulmonary examination is best when broken down into 4 basic parts: Inspection, palpation, percussion, and auscultation.

 
 
Contributor Information and Disclosures
Author

Joseph Z Springer, MD Resident Physician in Internal Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Nader Kamangar, MD, FACP, FCCP, FCCM Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Medicine, Olive View-UCLA Medical Center

Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: Academy of Persian Physicians, American Academy of Sleep Medicine, American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, Association of Pulmonary and Critical Care Medicine Program Directors, Association of Specialty Professors, California Sleep Society, California Thoracic Society, Clerkship Directors in Internal Medicine, Society of Critical Care Medicine, Trudeau Society of Los Angeles, World Association for Bronchology and Interventional Pulmonology

Disclosure: Nothing to disclose.

Richard S Tennant, MD Resident Physician in Internal Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

References
  1. Loudon RG. The lung exam. Clin Chest Med. 1987 Jun. 8(2):265-72. [Medline].

  2. Bickley LS, Szilagyi PG. The thorax and lungs. Bates' Guide to Physical Examination. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. 241-77.

  3. Schraufnagel DE, Murray JF. History and physical examination. Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th Ed. New York: Elsevier; 2010. 355-65.

  4. Maitre B, Similowski T, Derenne JP. Physical examination of the adult patient with respiratory diseases: inspection and palpation. Eur Respir J. 1995 Sep. 8(9):1584-93. [Medline].

  5. Cugell DW. Lung sound nomenclature. Am Rev Respir Dis. 1987 Oct. 136(4):1016. [Medline].

  6. Kraman SS. Lung sounds for the clinician. Arch Intern Med. 1986 Jul. 146(7):1411-2. [Medline].

  7. Epler GR, Carrington CB, Gaensler EA. Crackles (rales) in the interstitial pulmonary diseases. Chest. 1978 Mar. 73(3):333-9. [Medline].

  8. Koster ME, Baughman RP, Loudon RG. Continuous adventitious lung sounds. J Asthma. 1990. 27(4):237-49. [Medline].

  9. Scott G, Presswood EJ, Makubate B, Cross F. Lung sounds: how doctors draw crackles and wheeze. Postgrad Med J. 2013 Dec. 89(1058):693-7. [Medline].

  10. Nath AR, Capel LH. Lung crackles in bronchiectasis. Thorax. 1980 Sep. 35(9):694-9. [Medline].

  11. Nath AR, Capel LH. Inspiratory crackles and mechanical events of breathing. Thorax. 1974 Nov. 29(6):695-8. [Medline].

  12. Bettencourt PE, Del Bono EA, Spiegelman D, Hertzmark E, Murphy RL Jr. Clinical utility of chest auscultation in common pulmonary diseases. Am J Respir Crit Care Med. 1994 Nov. 150(5 Pt 1):1291-7. [Medline].

  13. DeGowin RL. The thorax and cardiovascular system. Degowin & Degowin's Diagnostic Examination. 6th Ed. New York: McGraw-Hill; 1994. 286-322.

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Pulmonary examination.
Pulmonary examination.
Pulmonary examination findings of common disorders.
Breath Sound Assessment. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
Table 1. Pulmonary Examination Findings of Common Disorders
DisorderPleural EffusionConsolidationEmphysemaPneumothoraxMucous Plug (With Collapse)
Examination finding
Tracheal deviationContralateralNoneNoneContralateralIpsilateral
FremitusDecreasedIncreasedDecreasedDecreasedDecreased
PercussionDullDullHyper-resonantHyper-resonantDull
PectoriloquyDecreasedIncreasedDecreasedDecreasedDecreased
Breath soundsDecreasedDecreasedCracklesDecreasedDecreased
Table 2. Differential Diagnoses of Crackles
Location in Respiratory CycleFineCoarse
 



Early inspiratory



Usual interstitial pneumonia



Desquamative interstitial pneumonia



Sarcoidosis



Miliary tuberculosis



Allergic alveolitis



Asbestosis



Chronic bronchitis



COPD



 



Late inspiratory



Atelectasis



Asthma



CHF



Pulmonary edema



Pneumonia/Consolidation



Scleroderma



Fibrosing alveolitis
 



Mid-inspiratory and expiratory



 Bronchiectasis, which can be secondary to the following:
  • Necrotizing pneumonia
  • Environmental exposures
  • Cystic fibrosis
  • Alpha-1 antitrypsin disorder
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