Dull and Stony Thoracic Percussion

MANUAL OF CLINICAL DIAGNOSIS

Thoracic percussion is a technique used in physical examination to assess the contents of the chest. A dull and stony percussion sound suggests the presence of dense material in the pleural space, such as fluid or solid tissue. This finding may indicate various pathologies that cause the accumulation of fluids or masses in the pleural cavity.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Transudate	Dyspnoea, orthopnoea, peripheral oedema, dull percussion	Medical history, physical examination, dull thoracic percussion	Pleural fluid analysis, thoracic ultrasound, chest computed tomography (CT)
Left Heart Failure	Exertional dyspnoea, orthopnoea, peripheral oedema, crackles	Medical history, physical examination, echocardiogram	Chest X-ray, echocardiogram, pleural fluid analysis
Decreased Serum Albumin	Fatigue, peripheral oedema, ascites	Medical history, physical examination, blood tests	Blood tests, pleural fluid analysis
Rare Causes	Dependent on underlying pathology	Medical history, physical examination	Specific tests according to the pathology
Exudates	Fever, chest pain, cough, dyspnoea, dull percussion	Medical history, physical examination, dull thoracic percussion	Pleural fluid analysis, culture, pleural biopsy
Infection	Fever, chills, productive cough, chest pain, dull percussion	Medical history, physical examination, dull thoracic percussion	Sputum culture, pleural fluid analysis, chest X-ray
Neoplasia	Weight loss, persistent cough, haemoptysis, chest pain, dull percussion	Medical history, physical examination, imaging	Chest X-ray, chest CT, pleural biopsy
Systemic Lupus Erythematosus	Joint pain, skin rash, fever, dyspnoea, dull percussion	Medical history, physical examination, blood tests	Pleural fluid analysis, serological tests
Pulmonary Infarction	Pleuritic chest pain, dyspnoea, haemoptysis, dull percussion	Medical history, physical examination, imaging	Chest CT, pleural fluid analysis, lung scintigraphy