Anatomic and Physiological Principles

• Cavity located along mediastinal, diaphragmatic positions and when surrounded by normal lungs are not detectable by exam.
• Cavity has to be close to chest wall to be recognized by exam.
• Physical findings depend whether the cavity is filled with fluid, empty, or half full.
• Communication with bronchi also is a determinant for the findings.
• In chronic cavitations there is associated surrounding fibrosis. 

Routine screening steps is often not useful in recognizing cavitation because of the variables. There are some characteristic findings for the cavity.

Focused exam

1. Cavernous Breathing: When the cavity is close to chest wall, when the cavity is empty and is in communication with bronchus one can hear a hollow high pitched bronchial breathing called cavernous breathing. The sound can be simulated by blowing over an empty pop bottle.
2. Post-Tussive Suction & Rales: Rarely one can hear a hissing noise following a cough. During cough the cavity collapses, and air enters with a hissing noise as the collapsed cavity fills with air. If there is fluid in cavity, crackles can be heard in addition - post tussive rales.
3. In chronic cavity findings of loss of lung volume due to associated fibrosis can be elicited.
4. You may encounter wasting of chest wall overlying cavity.
5. Clubbing can be seen associated with cavity due to lung abscess and malignancy.
6. One should look for signs of partial airway obstruction, as many of the cavities could be the result of post-obstructive pneumonias. Often one can elicit the findings of partial airway obstruction due to inflammation and chondromalacia of the leading bronchus.

   Succession splash is no elicitable even if the cavity has air- fluid level.