Table of Contents
NB: signs are on side of lesion unless otherwise stated.
Pulmonary fibrosis
- Oxygen therapy
- Dry cough
- Tachypnoea
- Reduced expansion
- Fine end-inspiratory crepitations
Signs of aetiology: hand deformity (RA), clubbing (idiopathic pulmonary fibrosis), sclerodactyly/telangiectasia/microstomia (systemic sclerosis), butterfly rash (SLE), lupus pernio (sarcoid), radiation burns, kyphosis (ankylosing spondylitis)
Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension)
COPD
- Bedside inhalers/nebulisers
- Accessory muscle use
- Tar-stained fingers
- Tachypnoea
- Lip pursing
- Reduced cricosternal distance (<3 fingers)
- Tracheal tug
- Indrawing of lower intercostal muscles on inspiration
- Hyper-resonance (with obliterated cardiac and hepatic dullness)
- Quiet breath sounds/wheeze/prolonged expiratory phase
Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension)
Pneumonectomy
- Unilateral chest flattening
- Thoracotomy scar
- Tracheal deviation (towards)
- Reduced expansion
- Dull percussion note
- Reduced breath sounds
- Bronchial breathing in upper zone (due to deviated trachea)
Signs of aetiology: cachexia/clubbed/tar-stained fingers (lung cancer)
Lobectomy
- Thoracotomy scar
- May be no other signs due to compensatory hyperexpansion of the remaining lobes
- May be some reduced expansion, dullness to percussion and reduced air entry
Signs of aetiology: cachexia/clubbed/tar-stained fingers (lung cancer), wet cough/clubbed/coarse crepitations (bronchiectasis), signs of COPD (bullectomy)
Pleural effusion
- Reduced expansion
- Stony dull percussion note
- Reduced breath sounds
- Reduced tactile fremitus and vocal resonance
Signs of aetiology: hand deformity (RA), clubbing/radiation marks (mesothelioma/lung malignancy), butterfly rash (SLE), lymphadenopathy (malignancy), signs of chronic liver disease (cirrhosis), pulmonary/peripheral oedema(heart failure)
Bronchiectasis
- Productive cough
- Inspiratory clicks
- Clubbing
- Coarse, late expiratory crepitations
Signs of aetiology: young and thin (CF), curved yellow nails and lymphoedema (yellow nail syndrome), lymphadenopathy (malignancy), dextrocardia(Kartagener’s syndrome)
Kyphoscoliosis
- Increased thoracic forward curvature or lateral curvature of the spine
- Reduced spine flexion/extension
- Rib hump
- Reduced chest expansion
Lung cancer
- Cachexia
- Clubbing
- Tar-stained fingers
- Hard irregular lymphadenopathy
- Radiation burns
Signs of complications: pain and swelling of wrists (hypertrophic pulmonary arthropathy), ptosis/meiosis/anhidrosis (Horner’s syndrome)
Lung transplant
- Mid-sternotomy/bilateral thoracotomy scar
Signs of aetiology: signs of COPD, clubbing (CF/idiopathic pulmonary fibrosis)
Signs of complications: cushingoid/bruising (steroid use)
