From the Guidelines
Ewart's sign is directly related to palpation, as it involves a physical examination finding characterized by dullness to percussion and bronchial breathing in the area below the angle of the left scapula. This sign occurs due to compression of the left lung by a large pericardial effusion. To detect Ewart's sign, a clinician palpates and percusses the patient's back in the left infrascapular region while the patient is sitting upright. The physiological basis for this sign involves the accumulation of fluid in the pericardial sac that compresses the adjacent left lower lobe of the lung, causing atelectasis (collapse) of lung tissue. This compression changes the normal resonant percussion note to a dull sound and allows for better transmission of bronchial breath sounds. While Ewart's sign is specific for large pericardial effusions, it is not very sensitive, meaning its absence does not rule out pericardial effusion, as noted in the guidelines for the diagnosis and management of pericardial diseases 1. Other clinical findings like muffled heart sounds, distant heart sounds, and pulsus paradoxus are often more reliable indicators of significant pericardial effusion. Key diagnostic findings for cardiac tamponade include pulsus paradoxus, which is due to exaggerated ventricular interdependence occurring in cardiac tamponade, as described in the European Society of Cardiology guidelines 1. The treatment of cardiac tamponade involves drainage of the pericardial fluid, preferably by needle pericardiocentesis, with the use of echocardiographic or fluoroscopic guidance, and should be performed without delay in unstable patients 1. In terms of diagnosis, echocardiography is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of haemodynamic impact, as stated in the guidelines 1. Overall, Ewart's sign is an important physical examination finding that can aid in the diagnosis of large pericardial effusions, and its detection involves palpation and percussion of the patient's back.
From the Research
Ewart's Sign and Palpation
- Ewart's sign is a clinical sign that can be detected through palpation, and it is related to pericardial effusion.
- The sign is characterized by a dullness or flatness to percussion over the area of the chest where the pericardial effusion is located, and it can be detected through physical examination, including palpation 2.
- However, the provided studies do not directly discuss Ewart's sign in relation to palpation, but they do mention the importance of physical examination and palpation in diagnosing pericardial effusion and cardiac tamponade 2, 3.
- The studies focus more on the echocardiographic evaluation of pericardial effusion and cardiac tamponade, highlighting the importance of echocardiography in diagnosing these conditions 4, 5, 3, 6.
- In one of the studies, palpation is mentioned as a method of measuring systolic blood pressure, which is an important vital sign in patients with pericardial effusion and cardiac tamponade 2.