Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Clinical Signs of Hydropneumothorax Empyema and Fibrothorax PowerPoint PPT presentation
It is the collection of both fluid(lower part) and
air(upper part) in the pleural cavity.
Common aetiology is secondary infection of an open
type of pneumothorax or sympathetic collection of
fluid in closed or tension pneumothorax.
CLINICAL PRESENTATION
Dyspnoea
Chest pain
Splashing sound during jolting
Cough
Heaviness in the chest
pyrexia
physical signs are more or less similar to
pneumothorax.
Decubitus-propped up position at present
INSPECTION
1.
Upper respiratory tract within normal limit
2.
Increased respiratory rate 30/min
3.
Diminished respiratory movements may be observed
PALPATION
1.
Diminished movement of chest in affected side
2.
Tracheal shift to opposite side
3.
Vocal fremitus is diminished
1. PERCUSSION
1.
straight fluid level( upper limit of dullness is horizontal.
Percussion done above downwards along
MCL,along MAL and back-marked at
point of dullness-3 points joined
transversely to get a horizontal line
encircling the chest wall.
2.
Shifting dullness (absent in loculated or encysted variety of
hydropneumothorax)
In sitting position-percussion done along MCL(
upper part is tumpanitic and lower part stony
dull)
Percussion done in lying down position when the
fluid gravitates in the depended part and air
comes in front
Lower part which was dull become tympanitic
Same manoeuvre can be done in the back
AUSCULTATION
1.
Succussion splash(hippocratic succussion)
Upper border of dullness is detected in lateral chest
wall along MAL in sitting position.now the diaphragm
of stethoscope is places on air fluid level and patient
shaken from side to side vigorously. A splashing sound
is heard with every jerk( like intact coconut)
2. Amphoric breath sound( bronchial breathing as
bronchopleural fistula is a common cause of HPT
3. Tinkling sounds
4. Positive coin sound in upper chest
Empyema thoracis
GENERAL EXAMINATION
1. Patient look toxic and prostrated,loss of weight
2. Hectic rise of temp with rigors and sweating
3. Tachycardia and tachypnoea
4. Clubbing
INSPECTION
1. Intercostal tenderness as well as fullness
2. Skin is red,oedematous,glossy overlying empyema
3. Empyema necessitans
PALPATION
1. Diminished movements on same side
2. Tracheal shift to opp side
3. Vocal fremitus diminished
PERCUSSION
1. Stony dullness
AUSCULTATION
1. Diminished vesicular breath sound on affected side.
2. Vocal resonance decreased
3. No adventitious sounds(
crepitations,rhonchi,pleural rub)
FIBROTHORAX
Long history
Commonly an end result of tuberculosis,empyema
thoracis,asbestosis or haemothorax.
INSPECTION
1. Crowding of ribs with drooping of the
sholders.depression of intercostal spaces with
reduced movements on affected side.
PALPATION
1. Trachea and apex beat may be shifted towards the
diseased side.
PERCUSSION
1. Dull note but never stony dull
AUSCULTATION
1. Diminished vesicular breath sound with diminished
vocal resonance.Bronchial breath sound is never
heard.Pleural rub may or may not be present.
This post was last modified on 12 August 2021