Prior to enrollment of the first subject, each examiner was taught the technique of AusP as described by Guarino (Fig 1). Briefly, the patient sat with the examiner behind or on either side of the patient. Before examination, the patient was told to cough to clear retained secretions and then breathe normally. The examiner then directly percussed over the manubrium by tapping lighdy with the distal phalanx of the index or middle finger of one hand while listening with the diaphragm piece applied by the other hand to the posterior chest wall. Percussion was applied with equal intensity over the same area of the manubrium while the stethoscope explored both lung fields to detect differences in sound transmission. It was applied alternately on one side of the chest and then the other in the same horizontal plane and at corresponding anatomic areas from apex to base, to provide comparison of sound transmission between the two sides. The stethoscope was then applied with the same technique over the paravertebralareas to detect possible mediastinal and hilar masses.
In healthy patients there should be no difference between the two sides in transmission of sound vibrations; an abnormality is detected by change in quality, pitch, duration, or intensity. Dullness to AusP was not graded, but results of each lung examination were described as normal, abnormal, or equivocal.
The techniques of indirect percussion and auscultation as described by DeGowin and DeGowin were also used. Voice sounds were not elicited during the ConA examination. Results of percussion and auscultatory examinations were also described as normal, abnormal, or equivocal. Specific findings of rales, rhonchi, and wheezes were noted during auscultatory examination. A single radiologist, unaware of the physical examination findings, evaluated all radiographs. Right and left lungs were treated independently. These findings were compared with the official written radiology report and if compatible, were used as the final readings. If there were discrepancies, a third radiologist was consulted as an arbitrator. Chest radiographs of each lung and mediastinum were evaluated independently of the clinical history and were reported as normal, abnormal or equivocal. Specific radiologic findings were also noted.
Figure 1. Auscultatory percussion of the lungs, as described by Guarino.