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Conventional physical examination of the chest can miss pleural effusion in obese patients or those with small effusions or thick chest walls; it also cannot distinguish pleural effusion from pleural thickening or underlying lung disease. This study assessed the ability of auscultatory percussion to detect free pleural fluid.
The technique was taught to 60 medical students, 15 residents, and five senior faculty: With the patient upright, a stethoscope is placed below the last rib in the midclavicular line, while the free hand applies direct percussion from the apex to the base. A change from a dull to a sharp, loud percussion note anywhere above the last rib indicates pleural fluid. This finding is confirmed by a shift in the detected fluid …