What is the time course of these findings?
Variable, with crackles and diminished breath sounds usually appearing first, bronchial breath sounds and
egophony developing 1–3 days after onset of symptoms (i.e., cough and fever), and dullness to percussion (plus increased tactile fremitus) occurring even later. This time lag usually allows for x-ray to preempt diagnosis, thus making exam irrelevant, since early detection by imaging translates into early institution of antimicrobial therapy, which in turn leads to aborted or never-developed physical findings. Hence, physical exam may be entirely normal in patients with pneumonia.
Variable, with crackles and diminished breath sounds usually appearing first, bronchial breath sounds and
egophony developing 1–3 days after onset of symptoms (i.e., cough and fever), and dullness to percussion (plus increased tactile fremitus) occurring even later. This time lag usually allows for x-ray to preempt diagnosis, thus making exam irrelevant, since early detection by imaging translates into early institution of antimicrobial therapy, which in turn leads to aborted or never-developed physical findings. Hence, physical exam may be entirely normal in patients with pneumonia.