The most typical complaints of the patient with respiratory pathology dyspnoea, cough,

Theme of lecture: Theme of lecture: Symptoms and Symptoms and

syndromes in diseases of syndromes in diseases of respiratory organs based respiratory organs based

on data of inquiry and on data of inquiry and general inspection of a general inspection of a patient, palpation and patient, palpation and percussion of a chestpercussion of a chest

N. BilkevychN. Bilkevych

The most typical complaints of The most typical complaints of the patient with respiratory the patient with respiratory pathologypathology

• dyspnoea,dyspnoea,• cough, cough, • bloody expectorations, bloody expectorations, • pain in the chest. pain in the chest. • Fever, asthenia, indisposition and Fever, asthenia, indisposition and

loss of appetiteloss of appetite (secondary (secondary complaints)complaints)

• DyspnoeaDyspnoea in its manifestation can be in its manifestation can be subjectivesubjective, , objectiveobjective, or , or subjective and subjective and objective simultaneously.objective simultaneously.

• Subjective dyspnoea - the subjective feeling of Subjective dyspnoea - the subjective feeling of difficult or laboured breathing.difficult or laboured breathing.

• Objective dyspnoea is determined by objective Objective dyspnoea is determined by objective examination and is characterized by changes in examination and is characterized by changes in the respiration rate, depth, or rhythm, and also the respiration rate, depth, or rhythm, and also the duration of the inspiration or expiration. the duration of the inspiration or expiration.

• Diseases of the respiratory system are often accompanied by Diseases of the respiratory system are often accompanied by mixed (i.e. subjective and objective) dyspnoea. It is often mixed (i.e. subjective and objective) dyspnoea. It is often associated with rapid breathing (tachypnoea). These associated with rapid breathing (tachypnoea). These symptoms occur in pneumonia, bronchogenic cancer, and in symptoms occur in pneumonia, bronchogenic cancer, and in tuberculosis. Cases with purely subjective dyspnoea (in tuberculosis. Cases with purely subjective dyspnoea (in hysteria, thoracic radiculitis) or purely objective dyspnoea (in hysteria, thoracic radiculitis) or purely objective dyspnoea (in pulmonary emphysema or pleural obliteration) occur less pulmonary emphysema or pleural obliteration) occur less frequently. frequently.

Three types of dyspnoea are Three types of dyspnoea are differentiated by the prevalent breathing differentiated by the prevalent breathing phase: phase: inspiratory dyspnoea, inspiratory dyspnoea, expiratory dyspnoea and mixed expiratory dyspnoea and mixed dyspnoeadyspnoea when both expiration and when both expiration and inspiration become difficult.inspiration become difficult.

Dyspnoea may be Dyspnoea may be physiologicalphysiological (caused by heavy exercise) and (caused by heavy exercise) and pathological pathological (associated with (associated with pathology of the respiratory organs, pathology of the respiratory organs, diseases of the cardiovascular and diseases of the cardiovascular and haemopoietic systems, and poisoning).haemopoietic systems, and poisoning).

Aetiology of dyspnoea in Aetiology of dyspnoea in respiratory pathology respiratory pathology

obstruction of the respiratory ducts obstruction of the respiratory ducts (expiratory) due to (expiratory) due to inflammatory oedema and inflammatory oedema and swelling of fine bronchi and bronchioles swelling of fine bronchi and bronchioles mucosa, or else in spasms in the smooth mucosa, or else in spasms in the smooth muscles (bronchial asthma), mechanical muscles (bronchial asthma), mechanical obstruction in the upper respiratory ducts obstruction in the upper respiratory ducts (larynx, trachea) (larynx, trachea)

contraction of the respiratory surface of the contraction of the respiratory surface of the lungs due tolungs due to their compression by liquid or air accumulated in their compression by liquid or air accumulated in

the pleural cavity,the pleural cavity, decreased pneumatization of the lung in decreased pneumatization of the lung in

pneumonia, atelectasis, infarctionpneumonia, atelectasis, infarction decreased elasticity of the lungs.decreased elasticity of the lungs.

Pronounced dyspnoea which develops Pronounced dyspnoea which develops suddenly is called suddenly is called asphyxiaasphyxia. . Paroxysmal attacks of dyspnoea are Paroxysmal attacks of dyspnoea are called called asthmaasthma..

Bronchial asthma, in which an Bronchial asthma, in which an attack of dyspnoea occurs as a attack of dyspnoea occurs as a result of spasms of smaller bronchi result of spasms of smaller bronchi and is accompanied by difficult, and is accompanied by difficult, lengthy and noisy expiration, is lengthy and noisy expiration, is differentiated from cardiac asthma differentiated from cardiac asthma which is secondary to left heart which is secondary to left heart failure and is often accompanied by failure and is often accompanied by lung oedema with very difficult lung oedema with very difficult expiration.expiration.

CoughCough is a complicated reflex act is a complicated reflex act which is actually a defence reaction which is actually a defence reaction aimed at clearing the larynx, aimed at clearing the larynx, trachea, or bronchi from mucus or trachea, or bronchi from mucus or foreign material. An inflamed foreign material. An inflamed bronchial mucosa produces a bronchial mucosa produces a secretion which acts on the sensitive secretion which acts on the sensitive reflexogenic zones in the respiratory reflexogenic zones in the respiratory mucosa to stimulate the nerve mucosa to stimulate the nerve endings and to activate the endings and to activate the coughing reflex. coughing reflex.

Cough may be:Cough may be: dry and dry and moistmoist MorningMorning, evening and night , evening and night permanentpermanent and and periodicperiodic..

SputumSputum

HaemoptysisHaemoptysis is expectoration of is expectoration of blood with sputum during cough. blood with sputum during cough. The physician must determine the The physician must determine the origin of haemoptysis and the origin of haemoptysis and the amount and character of blood amount and character of blood expectorated with sputum. expectorated with sputum.

The amount of blood expectorated The amount of blood expectorated with sputum is mostly scant. Blood with sputum is mostly scant. Blood appears in the form of thin streaks, or appears in the form of thin streaks, or it may give diffuse colouration to the it may give diffuse colouration to the sputum, which can be jelly-like or sputum, which can be jelly-like or foamy. Cavernous tuberculosis, foamy. Cavernous tuberculosis, bronchiectases, degrading tumor and bronchiectases, degrading tumor and pulmonary infarction may be attended pulmonary infarction may be attended by lung haemorrhage, which is usually by lung haemorrhage, which is usually accompanied with strong cough.accompanied with strong cough.

Blood expectorated with sputum Blood expectorated with sputum can be fresh and scarlet, or altered. can be fresh and scarlet, or altered.

PainPain inin the chest the chest may arise may arise during the development of a during the development of a pathological condition in the pathological condition in the thoracic wall, the pleura, heart, and thoracic wall, the pleura, heart, and the aorta, and in diseases of the the aorta, and in diseases of the abdominal organs (by irradiation). abdominal organs (by irradiation).

Pain in the chest in diseases of the Pain in the chest in diseases of the respiratory organs depends on respiratory organs depends on irritation of the pleurairritation of the pleura

Localization of pain depends on the pathological Localization of pain depends on the pathological focus. Pain in the left or right inferior part of the focus. Pain in the left or right inferior part of the chest (pain in the side) is characteristic of dry chest (pain in the side) is characteristic of dry pleurisy. Inflammation of the diaphragmal pleurisy. Inflammation of the diaphragmal pleura may be manifested by pain in the pleura may be manifested by pain in the abdomen to simulate acute cholecystitis, abdomen to simulate acute cholecystitis, pancreatitis, or appendicitis.pancreatitis, or appendicitis.Pleural pain is often piercing, while in Pleural pain is often piercing, while in diaphragmal pleurisy and spontaneous diaphragmal pleurisy and spontaneous pneumothorax it is acute and intense. pneumothorax it is acute and intense. Pain is Pain is intensified in deep breathing, coughing, or intensified in deep breathing, coughing, or when the patient lies on the healthy side when the patient lies on the healthy side (t(the respiration movements in this position become more he respiration movements in this position become more intense in the affected side of the chest to strengthen friction intense in the affected side of the chest to strengthen friction of the inflamed pleura (rough from deposited fibrin).of the inflamed pleura (rough from deposited fibrin).

Pain lessens when the patient lies on the affected Pain lessens when the patient lies on the affected side. Pleural pain is also lessened when the side. Pleural pain is also lessened when the chest is compressed to decrease the respiratory chest is compressed to decrease the respiratory excursions.excursions.

General weaknessGeneral weakness

TuberculosisTuberculosis – 93 % – 93 % of patientsof patients.. Cancer -Cancer - 92 % 92 % of patientsof patients.. Purulent lung diseasesPurulent lung diseases – 90 % – 90 % of of

patients.patients.

SweatingSweating ((sudatio, sudatio, hyperhydrosis)hyperhydrosis)

Symptom of wet pillow with Symptom of wet pillow with smell of smell of rotten hayrotten hay ((tuberculosistuberculosis).).

Exaggerated sweating with chillsExaggerated sweating with chills ((abscess, gangroeneabscess, gangroene).).

Diffuse cyanosis in the case Diffuse cyanosis in the case of respiratory failureof respiratory failure

General appearance of a General appearance of a patient with pulmonary patient with pulmonary

emphysemaemphysema

History of present illnessHistory of present illness ((anamnesis morbi)anamnesis morbi)

When and under which When and under which circumstances did the circumstances did the disease developdisease develop, ,

Course of the diseaseCourse of the disease,, Past examinations and Past examinations and

treatment, their efficacytreatment, their efficacy ((in chronic diseasein chronic disease).).

Life historyLife history ( (anamnesis vitae)anamnesis vitae) Living conditions in childhoodLiving conditions in childhood.. Living and working conditions in the Living and working conditions in the

past and nowpast and now.. Diseases on the pastDiseases on the past Harmful habitsHarmful habits.. HeredityHeredity.. Allergy.Allergy.

Objective examinationObjective examination. . General General inspectioninspection (inspectio)(inspectio)

General condition of General condition of the patientthe patient..

State of State of conscioussnessconscioussness..

Bearing and gareBearing and gare.. WoiceWoice.. Skin and visible Skin and visible

mucosa.mucosa.

Data of objective examination of the patients Data of objective examination of the patients with respiratory pathology. with respiratory pathology.

The patient should be better examined in the upright The patient should be better examined in the upright (standing or sitting) position with the chest being (standing or sitting) position with the chest being naked. naked. Examination of the chest should be done according Examination of the chest should be done according to a definite plan:to a definite plan:

Static inspection:Static inspection: • general configuration of the chest (position of the general configuration of the chest (position of the

clavicles, supra- and subclavicular fossae, shoulder clavicles, supra- and subclavicular fossae, shoulder blades); blades);

• Chest symmetryChest symmetryDynamic inspection:Dynamic inspection: the type, rhythm and frequency of breathing, the type, rhythm and frequency of breathing, respiratory movements of the left and right shoulder respiratory movements of the left and right shoulder

blades, and of the shoulder girdle, blades, and of the shoulder girdle, involvement of the accessory respiratory muscles in the involvement of the accessory respiratory muscles in the

breathing act. breathing act.

The shape of the chest may be The shape of the chest may be normal normal or or pathologicalpathological. .

A A normalnormal chest is characteristic of healthy chest is characteristic of healthy persons with regular body built. persons with regular body built. Its right and left Its right and left sides are symmetrical, the clavicles and the sides are symmetrical, the clavicles and the shoulder blades should be at one level and the shoulder blades should be at one level and the supraclavicular fossae equally pronounced on both supraclavicular fossae equally pronounced on both sides. Since all people with normal constitution are sides. Since all people with normal constitution are conventionally divided into three types, the chest conventionally divided into three types, the chest has different shape in accordance with its has different shape in accordance with its constitutional type.constitutional type.

Pathological Pathological shape of the chest may be the result shape of the chest may be the result of congenital bone defects and of various chronic of congenital bone defects and of various chronic diseases (emphysema of the lungs, rickets, diseases (emphysema of the lungs, rickets, tuberculosis).tuberculosis).

Normal form of the chest.Normal form of the chest. 1.1. Normosthenic (conical) chestNormosthenic (conical) chest in subjects in subjects

with normosthenic constitution resembles a with normosthenic constitution resembles a truncated cone whose bottom is formed by truncated cone whose bottom is formed by well-developed muscles of the shoulder girdle well-developed muscles of the shoulder girdle and is directed upward. The anteroposterior and is directed upward. The anteroposterior (sterno vertebral) diameter of the chest is (sterno vertebral) diameter of the chest is smaller than the lateral (transverse) one, and smaller than the lateral (transverse) one, and the supraclavicular fossae are slightly the supraclavicular fossae are slightly pronounced. pronounced. ТТhe epigastric angle nears 90°. he epigastric angle nears 90°. The ribs are moderately inclined as viewed The ribs are moderately inclined as viewed from the side; the shoulder blades closely fit to from the side; the shoulder blades closely fit to the chest and are at the same level; the chest the chest and are at the same level; the chest is about the same height as the abdominal part is about the same height as the abdominal part of the trunk.of the trunk.

2. 2. Hypersthenic chestHypersthenic chest in persons with in persons with hypersthenic constitution has the shape hypersthenic constitution has the shape of a cylinder. The anteroposterior of a cylinder. The anteroposterior diameter is about the same as the diameter is about the same as the transverse one; the supraclavicular transverse one; the supraclavicular fossae are absent (level with the chest). fossae are absent (level with the chest). The epigastric angle exceeds 90°; the The epigastric angle exceeds 90°; the ribs in the lateral parts of the chest are ribs in the lateral parts of the chest are nearly horizontal, the intercostal space nearly horizontal, the intercostal space is narrow, the shoulder blades closely is narrow, the shoulder blades closely fit to the chest, the thoracic part of the fit to the chest, the thoracic part of the trunk is smaller than the abdominal trunk is smaller than the abdominal one.one.

3. 3. Asthenic chestAsthenic chest in persons with in persons with asthenic constitution is elongated, asthenic constitution is elongated, narrow (both the anteroposterior narrow (both the anteroposterior and transverse diameters are and transverse diameters are smaller than normal); the chest is smaller than normal); the chest is flat. The supra- and subclavicular flat. The supra- and subclavicular fossae are distinctly pronounced. fossae are distinctly pronounced. The epigastric angle is less than The epigastric angle is less than 90°. The ribs are more vertical at 90°. The ribs are more vertical at the sides, the tenth ribs are not the sides, the tenth ribs are not attached to the costal arch (costa attached to the costal arch (costa decima fluctuens); the intercostal decima fluctuens); the intercostal spaces are wide, the shoulder spaces are wide, the shoulder blades are winged (separated from blades are winged (separated from the chest), the muscles of the the chest), the muscles of the shoulder girdle are shoulder girdle are underdeveloped, the shoulders are underdeveloped, the shoulders are sloping, the chest is longer than sloping, the chest is longer than the abdominal part of the trunk.the abdominal part of the trunk.

Pathological chest.Pathological chest. 11. . Emphysematous (barrel-like) chestEmphysematous (barrel-like) chest resembles a hypersthenic chest in its shape, resembles a hypersthenic chest in its shape,

but differs from it by a barrel-like but differs from it by a barrel-like configuration, prominence of the chest wall, configuration, prominence of the chest wall, especially in the posterolateral regions, the especially in the posterolateral regions, the intercostal spaces are enlarged. This type of intercostal spaces are enlarged. This type of chest is found in chronic emphysema of the chest is found in chronic emphysema of the lungs. Active participation of accessory lungs. Active participation of accessory respiratory muscles in the respiratory act respiratory muscles in the respiratory act (especially m. sternocleidomastoideus and (especially m. sternocleidomastoideus and m. trapezius), depression of the intercostal m. trapezius), depression of the intercostal space, elevation of the entire chest during space, elevation of the entire chest during inspiration and relaxation of the respiratory inspiration and relaxation of the respiratory muscles and lowering of the chest to the muscles and lowering of the chest to the initial position during expiration become initial position during expiration become evident during examination of emphysema evident during examination of emphysema patients.patients.

2. 2. Paralytic chestParalytic chestresembles the asthenic chest. It is found in resembles the asthenic chest. It is found in

emaciated patients, in general asthenia and emaciated patients, in general asthenia and constitutional underdevelopment; it often occurs constitutional underdevelopment; it often occurs in grave chronic diseases, more commonly in in grave chronic diseases, more commonly in pulmonary tuberculosis and pneumosclerosis. pulmonary tuberculosis and pneumosclerosis. During examination of patients with paralytic During examination of patients with paralytic chest, marked atrophy of the chest muscles and chest, marked atrophy of the chest muscles and asymmetry of the clavicles and dissimilar asymmetry of the clavicles and dissimilar depression of the supraclavicular fossae can be depression of the supraclavicular fossae can be observed along with typical signs of aslhenic observed along with typical signs of aslhenic chest. The shoulder blades are not at one level chest. The shoulder blades are not at one level either, and their movements during breathing either, and their movements during breathing are asynchronous.are asynchronous.

Paralytic chestParalytic chest

3. 3. Rachitic chest (keeled or pigeon chest).Rachitic chest (keeled or pigeon chest). It It is characterized by a markedly greater is characterized by a markedly greater anteroposterior diameter (compared with the anteroposterior diameter (compared with the transverse diameter) due to the prominence transverse diameter) due to the prominence of the sternum (which resembles the keel of of the sternum (which resembles the keel of a boat.) The anterolateral surfaces of the a boat.) The anterolateral surfaces of the chest are as if pressed on both sides and chest are as if pressed on both sides and therefore the ribs meet at an acute angle at therefore the ribs meet at an acute angle at the sternal bone, while the costal cartilages the sternal bone, while the costal cartilages thicken like beads at points of their thicken like beads at points of their transition to bones (rachitic beads). As a transition to bones (rachitic beads). As a rule, these beads can be palpated after rule, these beads can be palpated after rickets only in children and youths.rickets only in children and youths.

4. Funnel and 5. 4. Funnel and 5. Foveated chestFoveated chest

Funnel chest Funnel chest has a funnel-shaped depression in has a funnel-shaped depression in the lower part of the sternum. This deformity the lower part of the sternum. This deformity can be regarded as a result of abnormal can be regarded as a result of abnormal development of the sternum or prolonged development of the sternum or prolonged compressing effect. In older times this chest compressing effect. In older times this chest would be found in shoemaker adolescents. would be found in shoemaker adolescents.

Foveated chestFoveated chest is almost the same as the funnel is almost the same as the funnel chest except that the depression is found chest except that the depression is found mostly in the upper and the middle parts of mostly in the upper and the middle parts of the anterior surface of the chest. This the anterior surface of the chest. This abnormality occurs in syringomyelia, a rare abnormality occurs in syringomyelia, a rare disease of the spinal cord.disease of the spinal cord.

The shape of the chest can readily The shape of the chest can readily change due to enlargement or diminution change due to enlargement or diminution of one half of the chest (asymmetry of the of one half of the chest (asymmetry of the chest). These changes can be transient or chest). These changes can be transient or permanent.permanent.

The The enlargementenlargement of the volume of one of the volume of one half of the chest can be due to escape of half of the chest can be due to escape of considerable amounts of fluid as the considerable amounts of fluid as the result of result of accumulation of accumulation of fluid in the fluid in the pleural cavity, or due to penetration of air pleural cavity, or due to penetration of air inside the chest in injuries inside the chest in injuries (pneumothorax). (pneumothorax).

One part of the chest may One part of the chest may diminishdiminish due to due to• pleural adhesion or complete closure of the pleural adhesion or complete closure of the

pleural slit after resorption of effusion (after pleural slit after resorption of effusion (after prolonged presence of the fluid in the pleural prolonged presence of the fluid in the pleural cavity); cavity);

• contraction of a considerable portion of the contraction of a considerable portion of the lung (pneumosclerosis);lung (pneumosclerosis);

• resection of a pan or the entire lung;resection of a pan or the entire lung;• atelectasis (collapse of the lung or its portion) atelectasis (collapse of the lung or its portion)

Respiratory movements of the chestRespiratory movements of the chest should be examined during inspection of should be examined during inspection of the patient. In physiological conditions the patient. In physiological conditions they are performed by the contraction of they are performed by the contraction of the main respiratory muscles: intercostal the main respiratory muscles: intercostal muscles, muscles of the diaphragm, and muscles, muscles of the diaphragm, and partly the abdominal wall muscles. The partly the abdominal wall muscles. The so-called accessory respiratory muscles so-called accessory respiratory muscles (mm. sternocleidomastoideus, trapezius, (mm. sternocleidomastoideus, trapezius, pectoralis major et minor, etc.) are pectoralis major et minor, etc.) are actively involved in the respiratory actively involved in the respiratory movements in pathological conditions movements in pathological conditions associated with difficult breathing.associated with difficult breathing.

The type, The type, frequency, depth frequency, depth and rhythm of and rhythm of respiration can be respiration can be determined by determined by carefully observing carefully observing the chest and the the chest and the abdomen. abdomen. Respiration can be Respiration can be costal (thoracic), costal (thoracic), abdominal, or abdominal, or mixed typemixed type..

Thoracic (costal) respiratioThoracic (costal) respiratio. Respiratory . Respiratory movements are carried out mainly by the movements are carried out mainly by the contraction of the intercostal muscles. contraction of the intercostal muscles. The chest markedly broadens and slightly The chest markedly broadens and slightly rises during inspiration, while during rises during inspiration, while during expiration it narrows and slightly lowers. expiration it narrows and slightly lowers. Abdominal respiration.Abdominal respiration. Breathing is Breathing is mainly accomplished by the mainly accomplished by the diaphragmatic muscles; during the diaphragmatic muscles; during the inspiration phase the diaphragm inspiration phase the diaphragm contracts and lowers to increase contracts and lowers to increase rarefaction in the chest and to suck in rarefaction in the chest and to suck in air into the lungs. air into the lungs.

Respiration rateRespiration rate may be may be determined by counting the determined by counting the movements of the chest or the movements of the chest or the abdominal wall, while the patient abdominal wall, while the patient is being unaware of the is being unaware of the procedure (during examination of procedure (during examination of his pulse, for example). In norm his pulse, for example). In norm the respiration rate is within 16-the respiration rate is within 16-20 breathing movements a min. 20 breathing movements a min. It is increased in dyspnea and It is increased in dyspnea and rises in the case of inhibition of rises in the case of inhibition of respiratory center. respiratory center.

Pathological changes of rhythm and depth of Pathological changes of rhythm and depth of respiration are as followsrespiration are as follows::

NN The type of respiration The type of respiration disorder disorder

In which pathological In which pathological conditions it takes place conditions it takes place

1.1. Kussmaul’s respiration Kussmaul’s respiration Deep comaDeep coma2.2. Cheyne-Stoke’s Cheyne-Stoke’s

respirationrespirationAcute and chronic Acute and chronic insufficiency of cerebral insufficiency of cerebral circulation and brain circulation and brain hypoxia, heavy poisoninghypoxia, heavy poisoning

3.3. Biot’s respiration Biot’s respiration Meningitis, agony with Meningitis, agony with disorders of cerebral disorders of cerebral circulation circulation

4.4. Grocco’s respiration Grocco’s respiration Early stages of the same Early stages of the same pathological conditions as (2)pathological conditions as (2)

Palpation of a chestPalpation of a chestIt is used for assessment of:It is used for assessment of: PainPain Elasticity of the chestElasticity of the chest Assessment of vocal fremitusAssessment of vocal fremitus Assessment of epigastric angleAssessment of epigastric angle

Assessment of vocal fremitusAssessment of vocal fremitus Intensifies on affected side:Intensifies on affected side:

Pulmonary tissue consolidation syndromePulmonary tissue consolidation syndrome Lessens on affected side:Lessens on affected side:

PneumosclerosisPneumosclerosis Bronchial tumor with partial obstruction of Bronchial tumor with partial obstruction of

bronchial lumenbronchial lumen Accumulation of small amount of fluid or Accumulation of small amount of fluid or

air in pleural cavityair in pleural cavity Pleural adhesionsPleural adhesions

Disappears on affected side:Disappears on affected side: Hydro- or pneumothoraxHydro- or pneumothorax

Lessens on both sides:Lessens on both sides: Pulmonary emphysemaPulmonary emphysema

Percussion of lungs Percussion of lungs ComparativeComparative TopographicTopographic

The rules of percussionThe rules of percussion ( (mediatemediate):): The plessimeter is index or medial The plessimeter is index or medial

finger of the left lungfinger of the left lung.. 2.2.Percussion strokes should be done Percussion strokes should be done

with terminal phalange of medial finger of with terminal phalange of medial finger of the right arm on the junction of medial and the right arm on the junction of medial and terminal phalange of plessimeter fingerterminal phalange of plessimeter finger..

The nales should be cut, arms of a The nales should be cut, arms of a doctor should be warm.doctor should be warm.

Comparative percussionComparative percussion Nornal percussion sound is Nornal percussion sound is

resonantresonant (clear pulmonary sound) (clear pulmonary sound) Pathological sounds:Pathological sounds: DullDull sound (pulmonary tissue sound (pulmonary tissue

consolidation, hydrothorax)consolidation, hydrothorax) ThympanicThympanic sound (abscess, cavern, sound (abscess, cavern,

pneumothorax)pneumothorax) HyperresonanceHyperresonance (bundbox sound): (bundbox sound):

pulmonary emphysemapulmonary emphysema

Pathological processes in Pathological processes in lungslungs

Topographic percussion Topographic percussion of lungsof lungs

Lower lung border positionLower lung border position Lower lung border respiratory Lower lung border respiratory

mobilitymobility Lungs apexes height and width Lungs apexes height and width

(Kroenig’s area).(Kroenig’s area).

Lower lung border Lower lung border positionposition

Elevated on the affected side:Elevated on the affected side: PneumosclerosisPneumosclerosis AthelectasisAthelectasis Hepato- or splenomegalyHepato- or splenomegaly PneumoniaPneumonia HydrothoraxHydrothorax LobectomiaLobectomia

Elevated on both sides:Elevated on both sides: PregnancyPregnancy MeteorismMeteorism AscitesAscites

Lower liver border Lower liver border mobilitymobility

Lower lung border Lower lung border positionposition

Displaced downward on the affected Displaced downward on the affected side:side: PneumothoraxPneumothorax

Displaced downward on both sides:Displaced downward on both sides: Pulmonary emphysemaPulmonary emphysema SplanchnoptosisSplanchnoptosis

Sizes of lungs apexesSizes of lungs apexes Diminish (on the affected side):Diminish (on the affected side):

Pneumosclerosis of upper lobe Pneumosclerosis of upper lobe (tuberculosis)(tuberculosis)

LobectomiaLobectomia Increase:Increase:

Pulmonary emphysemaPulmonary emphysema

Bronchoscopy Bronchoscopy

IndicationsIndications: : suspition on tumoursuspition on tumour, , foreign bodies of airwaysforeign bodies of airways, , hemopthysis ans lung bleeding hemopthysis ans lung bleeding as well as for sanation of airwaysas well as for sanation of airways

The procedure is executed on The procedure is executed on fasting stomach under local fasting stomach under local anaestesia or narcosisanaestesia or narcosis

It is possible to take material It is possible to take material (mucosa) via biopsy (mucosa) via biopsy for for histological investiogationhistological investiogation..

X-ray examinationX-ray examination Plain X-ray is in Plain X-ray is in

wide usewide use contrast X-ray contrast X-ray

(bronchigraphy) (bronchigraphy) lets to assess lets to assess bronchial tree bronchial tree and is executed and is executed on fasting on fasting stomachstomach. .