MANUAL OF CLINICAL DIAGNOSIS
Thoracic percussion is a technique used in physical examination to assess the contents of the chest. A dull percussion sound, but not stony, 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 |
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