Last reviewed 01/2018

The character of the sound produced by percussion of the chest wall is important in the examination of the respiratory system.

For a right-handed examiner:

  • the middle finger of the left hand is placed firmly on the chest wall of the patient
  • the middle phalanx of the left middle finger is struck by the middle finger of the right hand
  • the palm and other fingers are lifted clear of the chest to prevent any damping of the vibrations
  • both sides of the chest should be percussed
  • thought should given to the surface anatomy of the lungs
  • the two sides of the chest are compared
  • if an area of dullness is found then its limits are demarcated by percussing from a resonant to a dull area

Changes in resonance are seen in the following conditions:

  • increased resonance:
    • emphysema
    • pneumothorax

  • decreased resonance:
    • consolidation
    • collapse
    • abscess
    • neoplasm
    • fibrosis

  • stony dull:
    • pleural effusion