What to write in interpretation in percussion during cvs examination in pediatrics
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CVS percussion pediatric examination interpretation cardiac dullness borders children
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percussion CVS cardiovascular examination pediatric cardiac dullness interpretation
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Percussion in CVS Examination - Pediatrics: What to Write in Interpretation
Percussion has limited practical value in cardiovascular examination in children, but it is expected in academic clinical exams and must be performed and documented correctly.
What You Are Percussing For
You are defining the cardiac borders by detecting the transition from resonant (lung) to dull (heart) percussion notes, and identifying the area of cardiac dullness.
Two Areas of Dullness to Know
| Type | Cause | What it Represents |
|---|---|---|
| Absolute cardiac dullness | Heart in direct contact with anterior chest wall (no lung in between) | Sternal and parasternal zone - gives a flat/dull note |
| Relative cardiac dullness | Lung partially overlies the lateral heart borders | Dull but less flat than absolute - represents true heart size |
Relative cardiac dullness corresponds to the true cardiac border and is the more clinically meaningful measurement.
Technique (Brief)
- Percuss from resonant (lung) to dull (heart) - lateral to medial
- Right border: Percuss 4th intercostal space, right side, from lateral to medial - note where resonance becomes dull
- Left border: Percuss obliquely in 3rd, 4th, and 5th intercostal spaces on the left - from lateral to medial
- Upper border: percuss vertically downward in the parasternal line
Normal Cardiac Border Landmarks (Adults; modified for children below)
| Border | Normal Position |
|---|---|
| Right border | ~2 cm to the right of sternum (right sternal edge), 3rd to 6th rib |
| Left border | Up to the apex beat position |
| Upper border | 3rd intercostal space, left parasternal |
In children (age-specific apex position):
- Infants/toddlers: Apex beat at 4th ICS, mid-clavicular line - left border of dullness should correspond to this
- Children (>5 years): Apex beat at 5th ICS, mid-clavicular line - same as adult
What to Write in the Interpretation
Normal finding (write this for normal exam):
"On percussion of the precordium, area of cardiac dullness is normal in extent. Right border of cardiac dullness is at the right sternal edge. Left border of cardiac dullness corresponds to the apex beat at the [4th/5th] intercostal space, mid-clavicular line. No extension of dullness beyond the apex beat. Percussion note is resonant over both lung fields bilaterally."
Abnormal findings and what they indicate:
| Finding | Write / Means |
|---|---|
| Dullness extending beyond the apex beat | Suggests pericardial effusion (most important use of percussion in CVS) |
| Increased area of dullness (left border shifted outward) | Cardiomegaly (left ventricular enlargement, dilated cardiomyopathy) |
| Decreased area of dullness | Pneumothorax (hyperresonance replaces dullness) |
| Dullness shifted to the right | Dextrocardia, right diaphragmatic hernia, left-sided collapse/effusion pushing heart right |
| Dullness shifted to the left | Right pneumothorax, right pleural effusion, right diaphragmatic hernia |
| Stony dullness at bases | Pleural effusion (in heart failure with basal effusions) |
Key Points to Remember for the Exam
- Percussion is not routinely used in pediatric CVS - its main use is suspecting pericardial effusion, where dullness extends beyond the apex beat
- Always correlate percussion findings with the apex beat - if the area of dullness extends beyond where you palpated the apex, suspect pericardial effusion
- In cardiomegaly, dullness and apex beat shift together laterally and downward
- In pneumothorax, the percussion note becomes hyperresonant over the affected side and you may lose cardiac dullness on that side
- Percussion findings must always be interpreted alongside palpation, auscultation, and the overall clinical picture
Sample Statement for an Academic Case Write-up
If normal:
"Percussion of the precordium reveals the right border of cardiac dullness at the right sternal edge and left border at the apex beat in the [4th/5th] ICS mid-clavicular line, appropriate for age. No abnormal extension of dullness is noted. Percussion note is resonant over both lung fields. No evidence of pericardial effusion on percussion."
If pericardial effusion suspected:
"On percussion, dullness extends beyond the palpated apex beat. The area of cardiac dullness appears increased, extending to the [X] ICS [X] cm lateral to the mid-clavicular line. This is consistent with pericardial effusion. Dullness was also noted over bilateral lung bases, suggestive of basal pleural effusion in the context of heart failure."
Sources: Color Atlas of Human Anatomy Vol. 2 (Internal Organs); Dr. Ghuman CVS Tutorial; PMC7149736 (The History and Physical Examination - Pediatric)
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