Ultrasound stethoscopy: a renaissance of the physical examination?

This year marks the 50th anniversary of echocardiography. The evolution of this noninvasive imaging modality has been impressive and has paralleled the rapid developments in microprocessor technology. Together with Doppler assessment of intracardiac haemodynamics, a comprehensive and diagnostic evaluation of most patients suspected of having heart disease is now possible. The method introduced new pathophysiologic concepts and has made unique contributions to the management of cardiac patients. Because of its availability and versatility in application, echo/Doppler has become the most widely used test to diagnose and quantify heart disease in many different health care environments. Cardiac ultrasound imaging continues to evolve rapidly and further miniaturisation of digital technologies has recently led to the construction of marvels of modern electronic bioengineering: real time, three dimensional echocardiography and, at the other end of the spectrum, small hand carried imaging devices. The basic physical examination as we practice it today was introduced by Pharaonic doctors and included history taking, inspection, palpation, and direct auscultation. In later times, doctors did not examine their patients. Renewed interest in the physical examination was stimulated by the pioneering work of GB Morgagni (1682–1771) who showed for the first time the pathologic changes induced in the organs by disease and how these cause signs and symptoms. Clinicians wanted to diagnose hidden pathology by detecting these signs at the bedside. It was the beginning of the “golden era” of physical diagnosis, with the great contributions of Auenbrugger, Corvisart, and Laennec. RTH Laennec (1781– 1826) revolutionised the physical examination by the introduction of the stethoscope, the first technological aid in clinical medicine. In fact, stethoscope is a misnomer (skopein = see) and stethophone (phone = sound) would have been more appropriate.