Percussion and Tactile Fremitus


LSU Physician Champion - Dr. Carol Mason


Percussion - Technique


Assessing the degree to which sound propagates through the lung. Air is resonant, and tissue is not performed by laying the middle finger of the non-dominant hand (as the only point of contact) over the area of interest on the chest wall and then striking the planted finger (the pleximeter) with the middle finger (only this one) of the dominant hand (the plexor), using a brisk motion (from the wrist) to thump the non-dominant middle finger. This takes practice and takes more than a gentle tap to elicit percussion correctly


Percussion

Percussion

Percussion - Continued


Percussion over normal lung tissue is resonant (like a drum) The resonance should be symmetric over the same area of the opposite side If the lung is separated from the parietal pleura (by a pleural effusion) or the lung is consolidated (with lobar pneumonia), percussion will be dull (like thumping a melon or book) Increased air in the chest (with pneumothorax or emphysema) causes percussion to be hyperresonant (accentuated hollowness) At the level of the diaphragm, normal resonance changes to dull as one percusses from above to below the diaphragm




Tactile Fremitus


- Palpation of the normal voice over the lung. The lower-pitched (typically male) voice is transmitted more readily than higher-pitched (typically female) voice sounds
- Elicited by placing the flat of the palms over the same region of both sides of the chest, and asking the patient to say “ninety-nine”
- Normal fremitus is accentuated in men vs women
- Normally accentuated in the right 2nd intercostal space anteriorly and in the interscapular areas bilaterally, due to the proximity of the underlying large right and left bronchi in these areas
- Reduced in setting of a pleural effusion
- Increased over consolidated lung (if the bronchus to that area is open)

Tactile Fremitus