Lung sounds with pneumonia4/9/2024 Palpation should focus on detecting abnormalities like masses or bony crepitus. Thoracic spine abnormalities such as kyphosis and scoliosis could also be noted during physical examination of the chest. Barrel chest could also be present which consists in increased anterior-posterior diameter of the chest wall and is a normal finding in children, but it is suggestive of hyperinflation with chronic obstructive pulmonary disease (COPD) in adults. Pectus carinatum is the exact opposite of pectus excavatum: in this anatomical abnormality, the sternum is protruding from the chest wall. The most common chest osseous abnormality is pectus excavatum where the sternum is depressed in to the chest cavity. Skeletal chest abnormalities should also be noted during the inspection. The position of the patient should also be noted, patients with extreme pulmonary dysfunction will often sit up-right, and in distress, they assume the tripod position (leaning forward, resting their hands on their knees).īreathing through pursed lips, often seen in cases of emphysema.Ībility to speak: patients that are unable to speak or become short of breath during the interview are likely to have a worse pulmonary function or reserve. ![]() The body habitus of the patient could provide information regarding chest compliance, especially in the case of severely obese patients were chest mobility, and compliance are reduced due to added weight from adipose tissue. ![]() The use of accessory breathing muscles (i.e., scalenes, sternocleidomastoid muscle, intercostal muscles) could point to excessive breathing effort caused by pathologies. During the inspection, the examiner should pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal breathing, costal markings, and use of accessory breathing muscles.
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