[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) › Chest percussion: resonance, dullness and hyperresonance [Clinical exam](https://durgical.com/en/clinical-exam/) · [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) # Chest percussion: resonance, dullness and hyperresonance - Exam technique Tapping the chest makes a sound that changes when air, fluid or solid tissue lies underneath. Updated 2026-11-01 **See it in 3D:** [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) · [Ribs (back part)](https://durgical.com/en/anatomy/ribs/) ## Key points - Resonance: aerated lung. Dullness: consolidation, atelectasis or effusion (effusion gives the flattest note). - Hyperresonance: pneumothorax, emphysema or an asthma attack with air trapping. - The technique is finger-on-finger: the striking middle finger hits the middle phalanx of the finger pressed on an intercostal space. - Diaphragmatic excursion is measured between the base at full expiration and full inspiration; normally several centimetres. - Percuss at symmetric points, comparing sides, and avoid the scapulae. ## What it is Percussion compares the sound made by tapping over different lung fields. Healthy air-filled lung is resonant; fluid or solid tissue sounds dull, and excess air sounds hyperresonant. Percussion also outlines the lung bases and measures diaphragmatic excursion. ## Landmark anatomy - The sound depends on the ratio of air to tissue beneath the finger, only a few centimetres deep. - On the right front, lung resonance turns dull over the liver, around the fifth intercostal space in the midclavicular line. - On the left, below the costal margin, the gas-filled stomach gives tympany (Traube space). - The costodiaphragmatic recess is where pleural fluid collects first in the upright position. ## Technique, step by step - Seat the patient with arms crossed in front to move the scapulae aside when percussing the back. - Press the middle finger of the non-dominant hand firmly on an intercostal space, with the palm off the wall. - With the tip of the other middle finger, strike the middle phalanx once or twice using the wrist, not the arm. - Lift the striking finger at once so the sound is not damped. - Percuss from apices to bases, alternating sides at symmetric points, behind, at the sides and in front. - Find the base: the point on the back where resonance turns dull, with the patient in expiration. - Ask for a held deep breath, find the border again and measure the distance: this is diaphragmatic excursion. ## Abnormal findings - Basal dullness with an upper border that rises toward the axilla: pleural effusion; just above it there may be a band of increased resonance. - Localized dullness with increased fremitus: consolidation. - One-sided hyperresonance with absent breath sounds: pneumothorax. - Bilateral hyperresonance with low, poorly moving bases: hyperinflation (COPD, severe asthma). - A high base on one side with little excursion: diaphragm paralysis, atelectasis or a subdiaphragmatic mass. ## Common errors - Striking hard or with the palm resting on the wall damps the note and blurs dull and resonant. - Percussing over ribs or scapula instead of intercostal spaces. - Small effusions and deep lesions do not change percussion; ultrasound and radiographs detect them better. ## Test yourself Think of the answer, then tap the question to see it. ## What percussion note is expected in pneumothorax? Hyperresonance or tympany on the affected side, with reduced or absent breath sounds. ## How is diaphragmatic excursion measured? Mark the posterior lung base at full expiration and again at full inspiration; the distance between the two points is the excursion. ## What causes tympany below the left costal margin? The gas-filled stomach (Traube space); its loss may be seen with a left effusion or splenomegaly. ## What note does a pleural effusion give and how is it told from consolidation? Marked basal dullness; in effusion fremitus and breath sounds fall, while in consolidation fremitus rises and bronchial breathing appears. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) - [Ribs (back part)](https://durgical.com/en/anatomy/ribs/) ## Related - [Chest palpation: expansion and tactile fremitus](https://durgical.com/en/clinical-exam/chest-palpation-expansion-and-tactile-fremitus/) - [Lung auscultation: normal breath sounds](https://durgical.com/en/clinical-exam/lung-auscultation-normal-breath-sounds/) - [The pleuropulmonary syndromes: the comparison table to know](https://durgical.com/en/clinical-exam/the-pleuropulmonary-syndromes-the-comparison-table-to-know/) - [Pleural effusion syndrome](https://durgical.com/en/clinical-exam/pleural-effusion-syndrome/) - [Pneumothorax syndrome](https://durgical.com/en/clinical-exam/pneumothorax-syndrome/) ## Related conditions - [Pleural effusion](https://durgical.com/en/conditions/pleural-effusion/) - [Pneumothorax](https://durgical.com/en/conditions/pneumothorax/) - [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/) - [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Pleural effusion: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000086.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Collapsed lung (pneumothorax)](https://medlineplus.gov/ency/article/000087.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Community-acquired pneumonia in adults: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000145.htm) (MedlinePlus, U.S. National Library of Medicine, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/