Since the onset of the AIDS pandemic, it has been shown that the lungs are one of the primary target organs of both infectious and noninfectious complications. In the most common HIV-related pneumonia in adults, Pneumocystis carinii pneumonia (PCP), results of the physical examination of the lung are often normal or with the occasional findings of fine rales, rhonchi, and wheezing. Tachypnea and exaggerated breath sounds are often found in advanced lung disease, but distinct signs of consolidation, such as rales, are unusual unless the lesion is of bacterial etiology.
The technique of auscultatory percussion (AusP) was originally described by Laennec2 and was adapted to outline various solid organs and fluid collections by Cammann and Clark. Gairdner s coin test for pneumothorax is a modification of auscultatory percussion. In 1974, Guarino described a modification that was used to detect pulmonary lesions. It was reported to have a high sensitivity in detecting pulmonary lesions, including viral and atypical pneumonias.
That AusP dullness was sometimes the only abnormality found in viral and atypical pneumonias led us to design a prospective, blinded study of pulmonary findings in hospitalized patients with HIV infection. This study was designed to compare performance characteristics of three physical examination techniques in patients with HIV infection: conventional percussion (ConP), conventional auscultation (ConA), and AusP, using chest radiographs as the gold standard.
One hundred thirty-eight patients with known or suspected HIV infection who were admitted to the Medical Service at University of California San Diego Medical Center between January and July 1992 were offered the opportunity to enroll in this study.
Within 48 h of admission, a standard chest radiograph (posteroantero and lateral) was obtained on every patient. After written, informed consent was obtained, a third-year medical student, an intern, and an attending physician attempted to examine each patient within 2 calendar days of his or her chest radiograph. The physical examination was restricted to the chest. The diagnosis of each patient, other than known or suspected HIV infection, was unknown to each examiner. No attempt was made to blind the examiners to the presence of other patient characteristics or medical equipment in the examination room.
Each of the three examiners employed three methods of examination: AusP, ConA, and ConP. The order of examination was randomized for each subject and each examiner. Data were kept on data sheets by each examiner and later input into a spreadsheet (Excel 4.0, Microsoft, Redmond, Wash) by the principal investigator.