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Schwartzstein's Physical Exam Tip of the Month

October, 2016: Left Upper Lobe Collapse

This paper describes an interesting case of cough and dyspnea. The patient has a Left Upper Lobe collapse. Note the volume loss in the left hemithorax on the PA film and the shift of the major fissure anteriorly on the lateral film. Remember, there is no minor fissure on the left, so the appearance for upper lobe collapse is very different on the left than on the right. The atelectatic lobe is “pancaked” against the anterior chest. You will never pick this up on the physical exam unless you percuss and auscultate the anterior chest as well as the posterior chest. Keep up the good work everyone!

September, 2016: Clubbing

Click here for article

Remember that clubbing is not just a change in the angle of the nail, but a softening or sponginess of the finger tissue at the nail bed. It is NOT associated with COPD nor with adult hypoxemia (in contrast to cyanotic disease of infants). It is associated with a number of factors including lung cancer and chronic inflammatory conditions in the lung (e.g., bronchiectasis) as well as some interstitial/fibrotic conditions of the lung. The exact mechanism by which it develops is unclear, but there are people, as demonstrated in the link above, who have remission of the clubbing when their lung cancer is removed, which suggests a humoral factor released by the tumor as a potential cause in those patients.