Clinical examination of chest is done in order to detect evidence of disease.
Chest examination consists of Inspection, Palpation, Percussion and Auscultation.
INSPECTION shows the configuration of the chest, the range of respiratory movement, and any inequalities on the two sides. The type and rate of respiration are also noted.
PALPATION enables the physician to confirm the impressions gained by inspection, especially of the respiratory movements of the chest wall. Abnormal protuberances or recession of part of the chest is noted. Abnormal pulsations are felt and tender areas detected.
PERCUSSION is a sharp tapping of the chest wall with the fingers. This produces vibrations that extend through the tissue of the thorax. Air-containing organs such as the lungs produce a resonant note; conversely, a more solid viscus such as the heart produces a dull note. With practice, it is possible to distinguish the lungs from the heart or liver by percussion.
AUSCULTATION enables the physician to listen to the breath sounds as the air enters and leaves the respiratory passages. The rate and rhythm of the heart can be confirmed by auscultation, and the various sounds produced by the heart and it’s valves during the different phases of cardiac cycle can be heard. It may be possible to detect friction sounds produced by the rubbing together of diseased layers of pleura or pericardium.
Note: To make these examinations, the physician must be familiar with the normal structure of the thorax and must have mental image of normal position of the lungs and heart in relation to identifiable surface landmarks.