Percussion: a clinical method of objective examination of the chest of a child

The lungs are percussed to assess the densities of the underlying organs. The resonance is heard in all lobes of the lungs that are not adjacent to other organs. Dullness is heard beginning in the fifth intercostal space in the right midclavicular line. When percussing down to the end of the liver, a flat sound is heard because the liver no longer overlaps the air-filled lung. Cardiac dullness is felt over the left sternal border from the second to fifth interspace medially to the midclavicular line. Below the fifth intercostal space on the left side, the eardrums result from the air-filled stomach. Deviations from these expected sounds are always recorded and reported.

In comparative chest percussion, the anterior part of the lung is percussed from apex to base, usually with the child supine or sitting. Each side of the chest is percussed in sequence to compare sounds, such as dulling of the liver on the right side with bloating of the stomach on the left. When striking the posterior lung, the procedure and sequence are the same, but the child must be seated. Normally only the resonance is of the head when percussing the posterior thorax from the shoulder to the eighth or tenth rib. At the base of the lungs, dullness is heard when the diaphragm is struck.

Pathological dullness is heard in case of

1.pneumonia

2. hydro-, hemothorax

3. pulmonary edema

4. Lung or mediastinal tumor

The banbox is heard in case of

1. emphysema of the lungs

2. lung cavern

3. lung abscess

4. pneumothorax

5. bronchial asthma

6. asthmatic bronchitis

In topographic percussion of the chest, the doctor looks for the edges of the lungs in the main lines, the location of the apex of the lung, and the width of the crenig areas. Topographic percussion is used only in children older than 7 years. In topographic percussion, the lung margin is assessed from the side of the resonant sound. The upper margin of the lung (location of the apex of the lung) is determined by percussion from the clavicle to the neck. The apex of each lung rises about 2-4 cm above the inner third of the clavicles in front of the body. In the posterior part we examined the location of the apex of the lung by percussion from the axis of the scapula to the seventh cervical vertebra. Normally, the upper border of the lung is on the seventh cervical vertebra at the back.

The lower costal margin of the lungs according to the age of the child

At 10 years old

• Midclavicular line

1. the right side is on the VI rib

midaxillary

2. the right side is on rib VII-VIII

3. the left side is on the IX rib

• Vertebral

1. the right side is on the IX-X rib

2. the left side is on rib X

Older than 10 years

• Midclavicular

1. the right side is on the VI rib

• Midaxillary

1. the right side is on the eighth rib

2. the left side is on the eighth rib

• Vertebral

1. the right side is on rib X

2. The left side is on rib X

The width of Crenig’s areas is determined by percussions from the middle of the muscular trapezius in each direction (towards the neck and shoulder) until the disappearance of resonance. Normally, the width of the Crenig areas is 3-5 cm.

Lung excursion is the distance between the lower costal margin of the lungs at maximum inspiration and maximum expiration. Normally the excursion of the lung is 2-6 cm.