What does dullness to percussion mean

To learn more about our GDPR policies click here. If you want more info regarding data storage, please contact gdpr jove. Your access has now expired. Provide feedback to your librarian. If you have any questions, please do not hesitate to reach out to our customer success team. Login processing This is a sample clip. Sign in or start your free trial. Previous Video Next Video. Overview Procedure Applications and Summary Transcript. Log in or Start trial to access full content. General percussion of the abdomen Explain the procedure to the patient Perform light percussion over each of the nine abdominal regions.

Normally, tympanic sound produced by air in the bowel loops will be heard. Tympanic sound is relatively long, high pitched, and loud. Occasional areas of dullness lower pitched, shorter, and quieter sound than tympany are produced by fluid and feces, and are normal as well. Large areas of dullness suggest an enlarged organ or a mass that has to be further assessed by palpation and additional maneuvers. Percuss the lower anterior chest above the costal margins.

Normally the spleen and liver are covered by the rib cage, with the liver edge occasionally found cm below the costal margin. Dull sound on the right over the liver is expected. On the left, tympany over the gastric air bubble and the splenic flexure of the colon should be heard. Percuss above the pubic symphysis.

Dullness on percussion in this area indicates an enlarged uterus or distended bladder. Determine the liver span Increased liver span on percussion indicates an enlarged liver, which can underlie a variety of pathological processes. Lightly percuss in the right midclavicular line upwards starting in the area of tympany below the umbilicus.

Bending down to listen carefully to the percussion note might be required. Make a mark where the tympany changes to dullness lower border with a skin pencil. Percuss in the right midclavicular line downwards starting at the nipple line to identify an upper border of liver dullness. Mark the point on the abdominal wall where the resonant sound over the lungs changes to dullness over the liver with a skin pencil.

Measure the distance between upper and lower border of dullness in cm. Liver span depends on age, sex, and body type. The liver span is normally cm mean liver span is 7 cm for women and If the liver span is increased, percuss laterally and medially.

Normal liver span in the midsternal line is cm. Percuss left anterior chest to detect splenomegaly The spleen is located slightly posterior to the left midaxillary line and produces an oval area of dullness between the 9 th and 11 th ribs.

Percussion of Traube's space, anterior axillary line, and left costal margin. Along with the other pathological conditions medial expansion of an enlarged spleen can produce dullness on percussion over Traube's space. With the patient supine and their left arm slightly abducted, percuss from the medial to lateral border of Traube's space. Dullness on percussion or reduction of the area of tympany can result from splenomegaly. The flanks are duller as posterior solid structures predominate, and the right upper quadrant is somewhat duller over the liver.

In contrast, the left upper quadrant may be tympanitic if there is an underlying gastric air bubble or splenic flexure of the colon filled with gas. There is good inter-rater reliability between clinicians in what represents a tympanitic note versus dull. Percussion can be used to estimate the vertical span of the liver. In the midclavicular line, the liver span is generally between six and twelve centimeters. A liver span greater than 12 cms is generally considered abnormal and consistent with hepatomegaly.

Variability in body habitus and certain disease states may influence where the liver is, and therefore where it is felt with palpation, but generally does not result in a change in span by percussion. But, a large amount is usually pathological. To perform a full exam for fluid, combine both percussion and palpation. While the patient is lying supine, fluid shifts to the flanks and the air-filled bowel moves anterior-superior.

For ascites percussion, percuss from the posterior axillary line in each flank, starting from the one furthest from you and head towards the midline. In a person with ascites, the flanks will sound dull and the midline should sound tympanic, creating an air-fluid level. Test for shifting dullness, which is a way to confirm that the dullness is caused by ascites. Have the patient roll towards you in the lateral decubitus position. If ascites is present, the air-filled bowel loops will shift and remain at the surface of the fluid and the air-fluid level will shift as well.

Figure 4. When percussing for ascites, a positive finding involves dullness over the flanks and tympany at midline when the patient is in the supine position. When the patient moves to a lateral decubitus position, the dullness will shift toward the table. Another test for ascites involves trying to illicit a fluid thrill. It can be seen in patients with very obvious ascites.

Elicit a fluid thrill by placing your left hand along the posterior left flank, and your right hand at the posterior right flank and gently tap with the tips of your right-hand fingers in a right to left motion. Note if there is a wave of fluid that hits your left hand. You can also use your fingers on the right hand to flick the abdomen at the right costal margin to see if there is a ripple of fluid that moves toward your left side. Figure 5.

Tap on the right and feel for a wave of fluid hitting your left hand. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account , which will give you access to free videos and downloads.

Acute Care and Trauma Surgeon at St. Dull or thudlike sounds are normally heard over dense areas such as the heart or liver.

Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors. Hyperresonant sounds that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults.

Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air, such as may occur in patients with COPD, or patients having an acute asthmatic attack. An area of hyperresonance on one side of the chest may indicate a pneumothorax.