Q&A: Correlation Of Chest Examination Findings and Chest Xray

The patient's history determines the scope and intensity of the chest examination. When the history elicits suspicion of the presence of a chest problem, the physical examination of the thorax must be expanded beyond a minimal screening examination to determine the nature of the problem so that a diagnosis can be made.

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In this article:
Component of chest exam
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Component of chest exam

The pulmonary examination consists of inspection, palpation, percussion, and auscultation. The inspection process initiates and continues throughout the patient encounter. Palpation, confirmed by percussion, assesses for tenderness and degree of chest expansion. Auscultation, a more sensitive process, confirms earlier findings and may help to identify specific pathologic processes not previously recognized.

MCQ: clinical scenario

A 50 year old woman visits a general practitioner because of a feeling of breathlessness (dyspnoea), especially on climbing the stairs to her house. She has never smoked in her life. On examination, the physician finds a central cyanosis, and the following is a photo of her hands.

On auscultation of her lungs, crepitations are heard bilaterally over the lower zones posteriorly, and there is increased tactile vocal fremitus. A chest X-ray is requested. The most likely finding on this Chest X-Ray is:

a) Consolidation
b) Pneumothorax
c) Pleural effusion
d) Coin lesion
e) Emphysema

MCQ: answer

The correct answer is A

MCQ: explanation

In this case the woman was diagnosed as having fibrosing alveolitis. Fibrosing alveolitis is a group of diseases of the lower respiratory tract that leads to the loss of the functional alveolar units and a limit in the transfer of oxygen from air to blood. There is widespread inflammation and deposition of scar tissue within the lung tissue. Gross clubbing of the fingers & toes occurs in fibrosing alveolitis.

Smoking increases the risk. People over 40 years old are affected more frequently. The incidence is 1 out of 1000 people. The cause is unknown. Currently, researchers believe that it may result from either an autoimmune disorder, a condition in which the body's immune system attacks its own tissues, or the after-effects of an infection, most likely a virus. A series of events takes place in which the inflammation occurs in the lungs and, eventually, the fibrosis processes become uncontrollable.

Increased vocal fremitus is due to scarred, consolidated lung. Vocal fremitus decreases when the bronchi are obstructed, and it is totally absent, when the lung is separated from the chest wall by pleural effusion or pneumothorax.

Reference(s)
1). Peter G Tuteur. Chapter 46: Chest Examination. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Walker HK, Hall WD, Hurst JW, editors. Boston: Butterworths; 1990. Bookshelf ID: NBK368PMID: 21250209