Tactile Fremitus:
“Tactile fremitus increases in intensity whenever the density of lung tissue increases, such as in consolidation or fibrosis, and will decrease when a lung space is occupied with an increase of fluid or air (e.g., pleural effusion, pneumothorax and emphysema). The causes of increased tactile fremitus include: Pneumonia, Lung tumor or mass, Pulmonary fibrosis, Atelectasis. Causes of decreased tactile fremitus include:
1 ) Unilateral: Bronchial obstruction with mucus plug or foreign object, Pleural effusion, Pneumothorax
2) Diffuse: Muscular or obese chest wall, Chronic obstructive lung disease”
http://www.ceu.org/cecourses/98730/ch4a.htm
Pleural fluid is associated with a dull-to-flat percussion note, decreased-to-absent tactile fremitus, and decreased-to-absent breath sounds.
A consolidation would be indicated by increased bronchial breath sounds and increased fremitus. Emphysematous blebs and pneumothorax are hyperresonant to percussion.
Breath sounds:
Sound travels faster through solids than through air and liquid. Thus, breath sounds are louder with consolidation and lower decreased with pleural effusion, PTX, or emphysema.
Percussion:
Normal lungs are resonant. Too much air in the lungs [e.g. emphysema, asthma, PTX (unilateral), large air-filled bulla (unilateral)] makes the lung hyperresonant. Dullness replaces the normal resonance of lungs when fluid or solid tissue replaces the air in the lungs (e.g. lobar pneumonia, pleural effusion, hemothorax, fibrous tissue, tumor, etc.)