Percussion Health Dictionary

A peculiar resonance heard sometimes on percussion of the chest over a cavity in the lung, resembling the jarring sound heard on striking a cracked pot or bell. It is also heard on percussion over the skull in patients with diseases of the brain such as haemorrhages and tumours, and in certain cases of fracture of the skull.... cracked-pot sound

An abnormal accumulation of CEREBROSPINAL FLUID, or CSF, within the skull, as a result of one or more of three main causes: (i) excessive CSF production; (ii) defective CSF absorption;

(iii) blockage of the circulation of CSF. Such disturbances in the circulation of the ?uid may be due to congenital reasons (most commonly associated with SPINA BIFIDA), to MENINGITIS, or to a tumour.

Symptoms In children, the chief symptoms observed are the gradual increase in size of the upper part of the head, out of all proportion to the face or the rest of the body. The head is globular, with a wide anterior FONTANELLE and separation of the bones at the sutures. The veins in the scalp are prominent, and there is a ‘crackpot’ note on percussion. The normal infant’s head should not grow more than 2·5 cm (1 inch) in each of the ?rst two months of life, and much more slowly subsequently; growth beyond this rate should arouse suspicions of hydrocephalus, so medical professionals caring for infants use centile charts for this purpose.

The cerebral ventricles are widely distended, and the convolutions of the brain ?attened, while occasionally the ?uid escapes into the cavity of the cranium, which it ?lls, pressing down the brain to the base of the skull. As a consequence of such changes, the functions of the brain are interfered with, and in general the mental condition of the patient is impaired. Untreated, the child is dull and listless, irritable and sometimes suffers from severe mental subnormality. The special senses become affected as the disease advances, especially vision, and sight is often lost, as is also hearing. Towards the end, paralysis is apt to occur.

Treatment Numerous ingenious operations have been devised for the treatment of hydrocephalus. The most satisfactory of these utilise unidirectional valves and shunts (tubes), whereby the cerebrospinal ?uid is bypassed from the brain into the right atrium of the heart or the peritoneal cavity. The shunt may have to be left in position inde?nitely.... hydrocephalus

Also known as tympanites, this is a distension of the ABDOMEN from excess gas or air in the INTESTINE or peritoneal cavity. On percussion the abdomen sounds resonant, like a drum. Causes include obstruction of the intestines, aerophagy (the swallowing of air), and IRRITABLE BOWEL SYNDROME (IBS). Treatment is of the underlying condition. (See also FLATULENCE.)... meteorism

The lengthening and intensi?cation of sound produced by striking the body over an air-containing structure such as the lung. Decrease of resonance is called dullness and increase of resonance is called hyper-resonance. The process of striking the chest or other part of the body to discover its degree of resonance is called PERCUSSION, and according to the note obtained, an opinion can be formed as to the state of consolidation of air-containing organs, the presence of abnormal cavities, and the dimensions and relations of solid and air-containing organs lying together. (See also AUSCULTATION.)... resonance

Spasm of the blood vessels in the ?nger, resulting in a white appearance. The condition is common in RAYNAUD’S DISEASE but it can be caused by the long-term use of percussion implements such as mechanical road drills or hammers. It is a recognised industrial disease. Treatment is to remove or treat the underlying cause.... white finger

The part of a medical consultation in which the doctor looks, feels, and listens to various parts of the patient’s body to assess the patient’s condition or to gather information to help make a diagnosis.

Most examinations include palpation, by which the doctor examines relevant parts of the body for signs such as swelling, tenderness, or enlargement of organs. In some cases, percussion of the chest, or other parts of the body, may be performed by tapping with the fingers and then listening to the sound produced. Auscultation may be used to listen to blood flow through arteries and sounds made by the heart and lungs. The doctor may take the pulse or blood pressure, examine the eyes and ears, and assess the strength and coordination of the muscles.... examination, physical

n. 1. the state of the lung in which the alveoli (air sacs) are filled with fluid produced by inflamed tissue, as in *pneumonia. It is diagnosed from its dullness to *percussion, bronchial breathing (see breath sounds) in the patient, and from the distribution of shadows on the chest X-ray. 2. the stage of repair of a broken bone following *callus formation, during which the callus is transformed by *osteoblasts into mature bone.... consolidation

(pleximeter) n. a small plate of bone, ivory, or other material pressed against the surface of the body and struck with a *plessor in the technique of *percussion.... plessimeter

(plexor) n. a small hammer used to investigate nervous reflexes and in the technique of *percussion.... plessor

(meteorism) n. distension of the abdomen with air or gas: the abdomen is resonant (drumlike) on *percussion. Causes include intestinal obstruction, functional bowel disorder, and *aerophagia.... tympanites

Pneumonia is an in?ammation of the lung tissue (see LUNGS) caused by infection. It can occur without underlying lung or general disease, or in patients with an underlying condition that makes them susceptible.

Pneumonia with no predisposing cause – community-acquired pneumonia – is caused most often by Streptococcus pneumoniae (PNEUMOCOCCUS). The other most common causes are viruses, Mycoplasma pneumoniae and Legionella species (Legionnaire’s disease). Another cause, Chlamydia psittaci, may be associated with exposure to perching birds.

In patients with underlying lung disease, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) or BRONCHIECTASIS as in CYSTIC FIBROSIS, other organisms such as Haemophilus in?uenzae, Klebsiella, Escherichia coli and Pseudomonas aeruginosa are more prominent. In patients in hospital with severe underlying disease, pneumonia, often caused by gram-negative bacteria (see GRAM’S STAIN), is commonly the terminal event.

In patients with an immune system suppressed by pregnancy and labour, infection with HIV, CHEMOTHERAPY or immunosuppressive drugs after organ transplantation, a wider range of opportunistic organisms needs to be considered. Some of these organisms such as CYTOMEGALOVIRUS (CMV) or the fungus Pneumocystis carinii rarely cause disease in immunocompetent individuals – those whose body’s immune (defence) system is e?ective.

TUBERCULOSIS is another cause of pneumonia, although the pattern of lung involvement and the more chronic course usually di?erentiate it from other causes of pneumonia.

Symptoms The common symptoms of pneumonia are cough, fever (sometimes with RIGOR), pleuritic chest pain (see PLEURISY) and shortness of breath. SPUTUM may not be present at ?rst but later may be purulent or reddish (rusty).

Examination of the chest may show the typical signs of consolidation of an area of lung. The solid lung in which the alveoli are ?lled with in?ammatory exudate is dull to percussion but transmits sounds better than air-containing lung, giving rise to the signs of bronchial breathing and increased conduction of voice sounds to the stethoscope or palpating hand.

The chest X-ray in pneumonia shows opacities corresponding to the consolidated lung. This may have a lobar distribution ?tting with limitation to one area of the lung, or have a less con?uent scattered distribution in bronchopneumonia. Blood tests usually show a raised white cell (LEUCOCYTES) count. The organism responsible for the pneumonia can often be identi?ed from culture of the sputum or the blood, or from blood tests for the speci?c ANTIBODIES produced in response to the infection.

Treatment The treatment of pneumonia involves appropriate antibiotics together with oxygen, pain relief and management of any complications that may arise. When treatment is started, the causative organism has often not been identi?ed so that the antibiotic choice is made on the basis of the clinical features, prevalent organisms and their sensitivities. In severe cases of community-acquired pneumonia (see above), this will often be a PENICILLIN or one of the CEPHALOSPORINS to cover Strep. pneumoniae together with a macrolide such as ERYTHROMYCIN. Pleuritic pain will need analgesia to allow deep breathing and coughing; oxygen may be needed as judged by the oxygen saturation or blood gas measurement.

Possible complications of pneumonia are local changes such as lung abscess, pleural e?usion or EMPYEMA and general problems such as cardiovascular collapse and abnormalities of kidney or liver function. Appropriate treatment should result in complete resolution of the lung changes but some FIBROSIS in the lung may remain. Pneumonia can be a severe illness in previously ?t people and it may take some months to return to full ?tness.... pneumonia

the sounds heard through a stethoscope placed over the lungs during breathing. Normal breath sounds are soft and called vesicular – they may be increased or decreased in disease states. The sounds heard over the larger bronchi are louder and harsher. Breath sounds transmitted through consolidated lungs in pneumonia are louder and harsher; they are similar to the sounds heard normally over the larger bronchi and are termed bronchial breath sounds. *Crepitations and *rhonchi are sounds added to the breath sounds in abnormal states of the lung. Amphoric or cavernous sounds have a hollow quality and are heard over cavities in the lung; the amphoric quality may also be heard in voice sounds and on percussion.... breath sounds