9.15 Anterior Thorax: Percussion **This is an advanced skill**
Percussion of the anterior thorax involves the following steps (see Video 12):
Step 1: Ensure the client is in an upright position, and then perform indirect percussion to evaluate the elicited sounds.
Step 2: Percuss in about four to eight locations on each side of the anterior thorax. See Figure 9.19 for the percussion pattern.
Step 3: On the anterior thorax, begin at the apices and move down to the bases, comparing side to side. In the supraclavicular region, start at the midclavicular line. As you move inferior to the clavicle, you should shift medially slightly, and then stay close to the sternum to avoid the breast tissue. Toward the bases, percuss close to the sternal line and move laterally.
- Keep in mind that the elicited sound will become dull as you percuss over the heart (second to fifth intercostal space on left side). Also, avoid percussing over breast tissue as this will elicit a dull sound, and avoid percussing over clavicles and ribs because this will elicit a flat note. To avoid the ribs, rock your finger back and forth to ensure you are in an intercostal space. Typically, you will skip the percussion step when the client has a muscular chest or a lot of adipose tissue as this will modify the normal resonant sound to a flat sound.
Step 4: Note the findings.
- Normal findings might be documented as: “Resonance heard throughout lungs on anterior thorax.”
- Abnormal findings might be documented as: “Dominant sound of resonance heard throughout lungs on anterior side except an area of 3 cm2 on left sternal border between clavicle and second rib.”
Video 12: Percussion of anterior thorax
