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Percussion – A Clinical Method of Objective Examination of a Child’s Chest

The lungs are percussed to assess the density of the underlying organs. Resonance is heard over all lung lobes that are not close to other organs. Dullness is heard starting at the fifth intercostal space in the right midclavicular line. Percussing down to the end of the liver, a flat sound is heard because the liver is no longer covering the air-filled lungs. Cardiac dullness is felt over the left sternal border from the second to the fifth interspace medial to the midclavicular line. Below the fifth intercostal space on the left side, the tympanum is the result of an air-filled stomach. Deviations from these expected sounds are always recorded and reported.

In comparative chest percussion, the anterior lung is percussed from apex to base, usually with the child in the supine or sitting position. Each side of the chest is percussed in sequence to compare sounds, such as liver dullness on the right side with gastric tympani on the left side. When percussing the rear lung wing, the procedure and sequence are the same, but the child should be sitting. There is usually only head resonance when percussing the posterior chest from the shoulder to the eighth or tenth rib. At the base of the lungs – dullness is heard when percussing the diaphragm.

Pathological dullness is heard in the case

1. pneumonia

2. hydro-, hemothorax

3. pulmonary edema

4. lung or mediastinum tumor

Banbox is heard in the case

1. emphysema of the lungs

2. cavernous lung

3. lung abscess

4. pneumothorax

5. bronchial asthma

6. asthmatic bronchitis

In topographic percussion of the chest, the doctor looks for the borders of the lungs in the main lines, the location of the top of the lungs and the width of the Krenig areas. Topographic percussion is used only in children older than 7 years. In topographic percussion, the edge of the lung is evaluated from the side of the resonant sound. The upper edge of the lung (the location of the lung apex) is determined by percussion from the collarbone to the neck. The top of each lung rises about 2-4 cm above the inner third of the clavicle in front of the body. At the back, we examine the location of the apex of the lung by percussion from the axis of the scapula to the seventh cervical vertebra. Normally, the upper limit of the lungs is at the seventh cervical vertebra at the back.

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

Up to 10 years of age

• Midclavicular line

1. the right side is at the VI rib

Midaxillary

2. the right side is at the VII-VIII rib

3. the left side is on the 9th rib

• Vertebral

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

The 2nd left side is on the X rib

Older than 10 years

• Midclavicular

1. the right side is at the VI rib

• Midaxillary

1. the right side is at the VIII rib

The 2nd left side is at the VIII rib

• Vertebral

1. the right side is on the X rib

2. The left side is on the X rib

The width of Crenig’s areas is determined by percussion from the middle of the muscular trapezium in each direction (to the neck and shoulders) until the resonance disappears. Normally, the width of Crenig’s areas is 3-5 cm.

Lung excursion is the distance between the lower costal edge of the lung during maximum inspiration and maximum expiration. Normal lung excursion is 2-6 cm.

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