From the Guidelines
Tidal percussion is not a significant or recommended technique in the physical examination for assessing ascites, as the provided evidence does not support its use or effectiveness. The presence of ascites is better assessed through other means, such as percussion of the flanks to detect flank dullness, which can indicate the presence of a significant amount of fluid in the abdominal cavity, approximately 1,500 mL or more, as noted in the study published in Hepatology 1. Key points to consider when assessing for ascites include:
- The presence of a full, bulging abdomen should lead to percussion of the flanks to check for flank dullness.
- If flank dullness is present, further testing for "shifting" can help confirm the diagnosis of ascites.
- The absence of flank dullness suggests that the patient has less than a 10% chance of having ascites, as indicated by the study 1.
- Other signs, such as the fluid wave and puddle sign, are not useful in diagnosing ascites, according to the evidence 1. In clinical practice, a thorough physical examination, including percussion and assessment for shifting dullness, is essential for evaluating patients with suspected liver disease, heart failure, or other conditions that may cause fluid accumulation in the peritoneal cavity.
From the Research
Significance of Tidal Percussion
- Tidal percussion is not directly mentioned in the provided studies, however, percussion in general is a significant aspect of physical examination.
- Percussion is a method of tapping body parts with fingers or small instruments to evaluate the size, consistency, borders, and presence of fluid/air in the lungs and abdomen 2.
- There are three main types of percussion sounds: tympanic, resonant, and dull, which can be used to diagnose various conditions such as pneumothorax and pleural effusion 3.
Detection of Pleural Effusion
- Auscultatory percussion (AP) is a technique that can be used to detect pleural effusion with high sensitivity and specificity 4.
- AP involves listening to the sounds produced by percussion over the chest and can detect as little as 50 mL of free pleural fluid 4.
- The use of AP can enhance detection of pleural effusion, especially in cases where conventional means of physical examination are insufficient 4.
Automation of Percussion
- The automation of percussion using a standardized percussion source and computerized classification of digitized signals can remove the subjective factor and other limitations of the technique 2.
- A system such as iApp can collect and analyze quantified data based on automatically performed inspection, auscultation, percussion, and palpation, and can successfully categorize abdominal divisions with high accuracy 5.
Clinical Utility
- Auscultatory percussion is a valuable addition to medical practice, bringing increased precision to physical diagnosis and improving the skill of palpation 6.
- The combination of auscultation and percussion can improve both auscultation and percussion, and can be used to evaluate the size of normal organs and abnormal masses 6.