1.11 : Respiratory System Abnormal Finding II: Palpation and Auscultation

In assessing respiratory abnormalities, palpation and auscultation are critical tools for detecting and interpreting various pathophysiological changes. These techniques provide insight into underlying disorders by evaluating tactile sensations and sounds produced by the respiratory system.

Palpation Findings

During a respiratory assessment, palpation can reveal several vital abnormalities:

• Tracheal Deviation: The displacement of the trachea from its normal midline position can be a significant finding. Tracheal shift, typically towards the unaffected side, might indicate a tension pneumothorax or a large pleural effusion requiring urgent attention.

• Altered Tactile Fremitus: Changes in the vibrations felt on the chest wall during speech indicate different lung conditions. Increased fremitus may suggest pneumonia or pulmonary edema, where fluid or consolidation enhances the transmission of vibrations. Conversely, decreased fremitus might be seen in conditions like pleural effusion or pneumothorax, where air or fluid interrupts the transmission.

• Altered Chest Movement: Observing the symmetry and extent of chest wall movement during breathing can provide clues about underlying respiratory conditions. Unequal chest movement often occurs in unilateral lung diseases such as atelectasis, pneumothorax, or pleural effusion. A generalized decrease in chest movement might be present in restrictive lung diseases or conditions causing global weakness of respiratory muscles.

Auscultation Findings

Auscultation of the lungs can identify various abnormal sounds that reflect disruptions in airflow and the lung parenchyma:

• Crackles: Fine crackles are short, high-pitched sounds at the end of inspiration, typically associated with conditions like idiopathic pulmonary fibrosis, early pulmonary edema, or pneumonia. Coarse crackles, longer and lower pitch, suggest more severe fluid accumulation, as seen in heart failure or severe pulmonary edema.

• Rhonchi: These are continuous, low-pitched sounds resembling snoring caused by obstructions in larger airways due to mucus, which might indicate chronic obstructive pulmonary disease (COPD) or cystic fibrosis.

• Wheezes: High-pitched, musical sounds, usually during expiration, indicate narrowed airways from bronchospasms, foreign bodies, or tumors.

• Stridor: A high-pitched, wheezing sound, especially notable during inspiration, is often caused by obstructions at the level of the trachea or larynx, seen in conditions like croup or foreign body aspiration.

• Pleural Friction Rub: A creaking or grating sound from inflamed pleural surfaces rubbing against each other during both phases of respiration, associated with pleurisy or pulmonary infarction.

• Voice Sounds: Changes in voice sound transmission through the lungs, such as bronchophony, whispered pectoriloquy, and egophony, are typically more pronounced in pneumonia or pleural effusion, reflecting enhanced lung density that carries sound more efficiently.

The findings from palpation and auscultation provide vital clues that help diagnose and manage respiratory conditions. Each abnormality detected by these methods offers insights into the possible etiology and anatomical changes occurring within the chest cavity, assisting clinicians in formulating appropriate therapeutic interventions.