Detection of Pneumonia by Auscultation of the Lungs in the Lateral Decubitus Positions

Abstract

Forty-five acutely ill, coughing patients, three with acute dyspnea and cardiomegaly, and 37 control subjects were placed in lateral decubitus positions for auscultation of their dependent lungs to determine if this maneuver would elicit inspiratory crackles, signs of pneumonia. In the upright position, auscultation of the lungs was normal in all control subjects and in lateral decubitus positions their dependent lungs revealed transient late inspiratory crackles in seven of the 37 (18.9%), and transient inspiratory peeling sounds in two others (5.4%). Thirteen acutely ill, coughing patients, free of prior cardiac and pulmonary diseases, had persistent late inspiratory crackles induced in one or both dependent lungs when placed in lateral decubitus positions. These dependent lungs also revealed increased numbers of crackles in three patients, late inspiratory squeaks in four, and wheezes in three others. In the upright position, auscultation of the lungs was normal in 10 of these patients, and a few basilar crackles were heard in three others. All of these abnormal findings cleared after treatment with antibiotics. Thirty-one of 32 acutely ill, coughing patients with bronchitis, sinusitis, or pharyngitis were free of induced crackles in dependent lungs in lateral decubitus positions. However, placement of two other patients in these positions appeared to have elicited the inspiratory crackles of chronic pulmonary disease and early congestive heart failure. These observations suggest that placement of acutely ill, coughing patients into lateral decubitus positions for auscultation of the dependent lungs may be a valuable maneuver for diagnosis of pneumonia.

Diagnosing Pneumonia by Physical Examination

“…A previously published study of rales in the LDP also found this finding useful in the detection of pneumonia. 10 In our study, direct percussion was of limited value in detecting pneumonia, and values were variable. Although auscultatory percussion had high specificity, values were low or unmeasurable.…”

Detection of Bronchial Breathing Caused by Pneumonia. Die Detektion der durch Pneumonie verursachten Bronchialatmung

“…Unfortunately findings obtained with a stethoscope are rather subjective [6,14]. It has been suggested, that an objective method such äs Computer based lung sound analysis could improve the Situation.…”

Die Lungenauskultation – Erkenntnisse und Irrtümer

“…In einer Studie über Auskultationsbefunde bei Pneu monien fanden die Untersucher bei 19 % der gesunden Kontrollen in seitlich liegender Posi tion spätinspiratorische Rasselgeräusche in der unten liegenden Lunge. Diese Nebengeräusche verschwanden aber nach ein bis zwei tiefen Atemzügen [22]. …”