CHEST PHYSICAL

EXAMINATION (LUNG) IN
INFANT & CHILDREN
HEDA MELINDA D.N
Pulmonology subdivision Child Health Department
Medical Faculty University of Padjadjaran

Physical examination

INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
SEQUENCE OF THESE STEPS VARIED

INSPECTION
Pattern of breathing
1. Respiratory rate
- count during 1 minute
- ideally several times average value
- abnormality :
tachypnea
bradypnea
hyperpnea
hypopnea

2. Rhythm

changes occur first month

(respiratory pauses < 10 sec (3 month)
periodic breathing (premature)
apnea
cheyne-stokes breathing
biot breathing
3. Respiratory effort
# increased Dyspnea
Objectives signs : - chest wall retraction
- used of accesory muscle alae nasi
- orthopnea
- paradoxical respiratory movement

 Symmetry of respiratory chest

excursion
asymmetric breathing movements
(unilateral disease affecting lung, pleura,
chest wall, diaphragma)
local paradoxical movements
(trauma to the rib cage)

Dimensions of the chest

chest circumference (mammilary level)

Inspection of extrathoracic regions

Signs for atopic individual

Signs cystic fibrosis
BCG scar
Clubbing
Cyanosis
Cardiovascular signs of pulmonary
disease

PALPATION
Confirm observed abnormalitis
Position of the trachea
Symmetry ninety-nine (to produce low
frequency vibrations) or crying FREMITUS VOCAL/
FREMITUS TACTILE
Abnormalitis :
# Decrease fremitus :
1. air or fluid in the pleural space
2. large consolidation
3. atelektasis

PERCUSSION
Performed by light tapping with the index or
middle finger on the terminal phalanx of the
other hands middle finger
* tympanic
* flat or dull
Symetrical
(anterior, lateral, posterior surface of the chest)

AUSCULTATION
Respiratory sounds :
- Oraginally : LAENNEC
- Translated into English : FORBES
1985. 10th Meeting of the International Lung Sounds
Association

Term is now accepted:

Crackles (fine & coarse)
Wheeze
Rhonchi (snore sound) related to airway secretion

AUSCULTATION
Normal lung sounds
1. Vesicular sound
= breath sound
2. Normal trachial sound
Adventitious respiratory sounds
indicate : respiratory disease
1. WHEEZES :
musical, continuous sound, originate from
oscillation in narrowed airways

2. CRACKLES

- non musical, discontinuous lung sounds

- fine or coarse crackles
(depending on duration & frequency of
vibrations)
3. PLEURAL RUBS
(inspiration and expiration)

4. GRUNTING
- expiratory sound
- produced in the larynx
5. STRIDOR
- narrowed extrathoracic airway
- most commonly during inspiration

LUNG SOUND NOMENCLATURE

English

French

German

Fine
crackles

Rales
crepitants

Feines
Raissein

Estertores
Finos

Estertores
Finos

Coarse
Crackles

Rales
bulleux ou
Sous
Crepitants

Grobes
Rassein

Estertores
Grossos

Estertores
Gruesos

Continuous
High piched

Wheezes

Pfeifen

Sibilos

Sibilancias

Low piched

Ronchus

Rales
sibilants
Rales
ronflant

Brummen

Roncos

Roncus

Discontnuous
Fine
(High pitched,low
amplitudo,short
duration)
Coarse
(low pitched,high
amplitudo,long
duration)

Japanese Portuguese

Spanish

Recommendation from the1985 International Symposium on Lung Sounds in Tokyo

For unified nomenclature of adventitious sounds (see Kendig, page 97)

Notes for discussions

1. Physical examination in :
1. Pleural effusion
2. Pneumonia
3. Bronchopneumonia
4. Pneumothorax
5. Atelectasis
2. Projection of pulmonary lobes on the chest
surface