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Refinements in diagnosis are always useful, and in the recognition of pleurisy with effusion, roentgen-ray facilities are not always at hand. For several years, I have found a method of auscultation with percussion of great service in detecting pleuritic effusion.
The bell of the stethoscope is placed in the lower axilla, when the patient is seated, and the spinous processes of the vertebrae are tapped gently from above downward with the percussion finger. If an effusion is present, a change to a note of higher and shorter pitch is detected at a spinous process which, in the case of the affected side, is above that of the normal side. In many instances, this change of tone accords with the apex of the Grocco triangle, and it does not in general coincide with the upper edge of the fluid content. The method should be practiced on normal persons, with the eyes
Webb GB. AUSCULTATORY PERCUSSION IN THE DIAGNOSIS OF PLEURAL EFFUSION. JAMA. 1927;88(2):99. doi:10.1001/jama.1927.92680280028010a
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