Creeping rales. Crepitus is a very serious symptom - types

Crepitation is an additional respiratory noise that occurs at the height of inspiration due to the unraveling of alveoli that have collapsed during exhalation and are moistened with sticky exudate. It sounds like a small crackling sound, reminiscent of the sound that occurs when kneading a tuft of hair near the ear with your fingers.

True alveolar crepitus is heard during lobar pneumonia in stages I (silent, crepitatio indux) and III (sonorous, crepitatio redux) stages, with pulmonary infarction, with pulmonary edema, with pulmonary atelectasis (in the area of ​​the collapsed lung, due to impaired blood circulation and lymphatic drainage, congestion occurs transudation into the alveoli).

False alveolar crepitus can sometimes be heard in people with normal lungs: over atelectatic areas of the lungs in weakened lying patients with shallow breathing, in elderly people after sleep or prolonged lying. It is usually heard in the lower parts of the lungs, symmetrically, similar in sound to true alveolar crepitus, but disappears after 3-4 deep breaths.

Moist rales that occur in the smallest bronchi (bronchioles) are similar to crepitus. They are called subcrepitants.

Differences between moist rales and crepitus

Pleural friction noise and the mechanism of its occurrence, distinctive features.

Pleural friction noise is a breathing noise that occurs when listening to the chest above the site of inflammation of the pleural layers.

Due to uneven inflammatory swelling of the pleural layers, deposits of fibrin on their surface, the surfaces of the pleural layers facing each other become rough. As a result of this, during respiratory movements, their friction produces a noise that has a great variety of sounds. The pleural friction noise is best heard in places of greatest respiratory mobility of the lungs in the lateral sections of the chest.

Pleural friction noise is heard with dry pleurisy, with exudative pleurisy after resorption of the exudate, with the formation of scars or adhesions between the layers of the pleura, with cancer or tuberculous contamination of the pleura, uremic intoxication, with severe dehydration of the body.

When the pleura becomes inflamed near the heart and fuses with the parietal layer of the pericardium, a so-called pleuropericardial murmur occurs.

Differences between pleural friction noise and wheezing and crepitus.

Pleural friction noise:

It can be heard both during inspiration and during expiration, and crepitus can only be heard during inspiration;

It is usually heard in the form of intermittent sounds of a varied nature, following each other, and wheezing, especially dry ones, are drawn-out sounds;

Does not change with coughing, but wheezing undergoes changes;

It may intensify when pressing on the chest with a stethoscope, but the nature of wheezing does not change;

When auscultated, it seems to occur closer to the examiner's ear than wheezing or crepitus,

It is heard when simulating breathing (the patient presses his fingers over his mouth and nose, imitates breathing, changing the position of the diaphragm - tensing and relaxing the stomach), but wheezing and crepitus are not.

Specific auscultatory phenomena detected in hydropneumothorax.

These sound phenomena are heard above the chest in patients with hydropneumothorax (the presence of fluid and air in the pleural cavity), less often in the presence of large air cavities containing a small amount of viscous pus. These include: the sound of splashing, the sound of a falling drop, the sound of a water pipe.

The sound of Hippocrates splashing (succusio Hyppokratis). The term "succusio" comes from the Latin. succus - juice, and the suffix sio, denoting action, i.e. - the literal translation of “succusio” is “the action of juice.” The sound of splashing can be heard if you grab the patient’s shoulders with both hands and quickly, energetically bring him towards you and then push him away a little.

The sound of a falling drop (gutta cadens) is observed in the presence of large pulmonary cavities, partially filled with thick pus, as well as in pyopneumothorax with the presence of thick viscous pus in the pleural cavity. It can be heard if the patient is quickly transferred from a lying position to a sitting position and immediately perform auscultation of the lungs. The liquid moves to the lower part of the pleural cavity or cavity, and individual drops, flowing from the surface of the pleural sheets or walls of the cavity, fall into the exudate and give the characteristic sound of a falling drop.

The sound of a water pipe occurs if the pleural cavity communicates through a fistula with a bronchus, and the opening of the fistula is below the upper level of the fluid. With each inhalation, air bubbles, entering through the fistula opening from the bronchus into the liquid and rising to its surface, produce a special bubbling sound, reminiscent of large bubble rales.

What is bronchophony? Methodology for its detection and diagnostic value.

The doctor uses a stethoscope to listen to various symmetrical areas of the lung, while the patient pronounces in the lowest possible voice words containing the letter “p” (eg “thirty-three”), and with pronounced compaction of the lung tissue, words containing hissing sounds can be heard ( n.p., “cup of tea”), spoken in a whisper. A necessary condition for bronchophony (as well as bronchial breathing) is the patency of the bronchus lying in compacted tissue.

Normally, there is no bronchophony. Bronchophony is an early and sometimes the only sign of compaction of the lung tissue, since compacted lung tissue is a good conductor of sounds and the words spoken by the patient will be clearly audible. Academician F.G. Yanovsky pointed out that bronchophony in pneumonia appears earlier than other physical symptoms.

Bronchophony can be determined above air-containing cavities (cavities) with a dense capsule due to resonance phenomena. In this case, bronchophony over the cavities often acquires a loud, amphoric character and is called amphorophony. Sometimes it can have a metallic tint, which is called pectoryquivia. Bronchophony can be detected over the area of ​​compression atelectasis formed as a result of compression of the lung by pleural effusion; it is heard in upper limit pleural effusion may have a rattling, nasal sound. It is called egophony.

Bronchophonia is noted when bronchial breathing and increased vocal tremors can be determined by physical conditions.

Questions for self-control of knowledge.

Test control tasks.

1. Mixed breathing can be heard when:

a) focal pneumonia;

b) bronchitis;

c) incomplete compression atelectasis;

d) in the jugular fossa;

e) above the apex of the right lung.

2. Hard breathing is characterized by the following: P signs:

a) heard during bronchitis;

b) heard only during inspiration;

c) due to a slight narrowing of the lumen of the bronchi;

d) all answers are correct.

3. Consonant moist rales are heard when:

1) pneumonia;

2) bronchitis;

3) lung abscess;

4) dry pleurisy;

5) cavernous tuberculosis.

Correct: A - 1, 2, 3. B - 2, 3, 4. C - 1, 3, 5. D - 1, 2.

4. Indicate where moist rales may form:

a) alveoli;

b) bronchi;

c) trachea;

d) pleural cavity;

e) cavities.

5. The causes of pathological bronchial breathing are:

a) pulmonary emphysema;

b) acute bronchitis;

c) lobar pneumonia;

d) tuberculous lung cavity;

e) compression atelectasis;

e) valvular pneumothorax.

6. Moist, sonorous rales over the lungs are heard when:

a) pulmonary edema;

b) during the peak period acute bronchitis;

c) pneumonia;

d) lung abscess;

7. Bronchophony is detected when:

a) pulmonary emphysema;

b) pneumonia;

c) bronchitis;

d) bronchial asthma;

e) none of the above options.

8. What additional noises are heard during hydropneumothorax:

a) wet rales;

b) the sound of a falling drop;

c) saccadic breathing;

d) the sound of Hippocrates splashing;

d) all answers are correct.

9. Features crepitus:

a) heard only during inspiration;

b) changes when coughing;

c) intensifies when pressing on the chest with a stethoscope;

d) accompanied by pain in chest;

e) none of the above.

10. Pathological weakening of vesicular respiration is observed when:

a) bronchitis;

b) pneumothorax;

c) hydrothorax;

d) pulmonary emphysema;

e) in all of the above cases.

11. The main signs of fine bubbling rales include all except:

a) arise in small bronchi and bronchioles;

b) arise in the alveoli;

c) heard during inhalation and exhalation;

d) intensify when the stethoscope is pressed on the chest;

d) change after coughing.

12. The sound of a falling drop can be heard above the chest To taphole at:

a) lobar pneumonia;

b) focal pneumonia;

c) pulmonary edema;

d) pneumothorax;

e) hydropneumothorax;

f) a large lung cavity containing viscous pus.

13. Auscultatory signs of broncho-obstructive syndrome are all except:

a) prolongation of the expiratory phase;

b) dry wheezing during exhalation;

c) amphoric breathing;

d) wet consonant rales;

Crepitus I Crepitation (crepitatio; lat. crepitare to creak, crunch)

crackling or crunching, detected by auscultation or palpation. There are alveolar, subcutaneous and bone crepitus.

Bone crepitus is a crunch that occurs from mutual friction of contacting bone fragments; is detected, as with subcutaneous K., by palpation and auscultation. It is a specific symptom of a fracture and is used to diagnose fractures when examining the victim on the spot (before X-ray examination). With complex injuries (for example, a combination of rib fractures and rupture of lung tissue), the simultaneous appearance of bone and subcutaneous crepitus is possible.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Crepitation” is in other dictionaries:

- (Latin, from crepitare). 1) a special kind of cracking sound produced by the broken ends of a bone when palpated. 2) a special crunching sound heard during auscultation of the lungs, proving that there is fluid in the lung cells. 3) special crackling... Dictionary of foreign words of the Russian language

ICD 9 719.60719.60, 756.0756.0 Crepitation is a characteristic crunching sound that is important in medical diagnosis. The term “crepitus” in medicine describes several different sounds... Wikipedia

CREPITUS- (from the Latin crepitus crackle), a sound reminiscent of the crackling of salt being fried (Laennec), the friction of hair against each other, etc. In the lungs, K. is caused by the penetration of a strong stream of air into the alveoli, the walls of which are stuck together due to compression or the presence of ... ... Great Medical Encyclopedia Explanatory dictionary of medicine

- (crepitatio; lat. crepito to creak, crunch) a crunching or crackling sensation that occurs during palpation or auscultation ... Large medical dictionary

Crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation, crepitation (

Crepitus is a barely audible but melodic pathological sound that comes from various tissues. This sound is a bit like the light crackling sound that appears when you lightly rub dry hair near your ear. In addition, the sound is a bit like the crunch of dry snow underfoot, but it is much quieter. Crepitus is a very rare symptom of pathology of various tissues. Some diseases can be easily identified by this specific sound.

Varieties

Crepitus is a characteristic symptom that occurs in certain diseases. There are few such pathologies and they can be associated with different tissues:

• Crepitus in the lungs - this phenomenon is observed when the lungs are filled with exudate or other liquid. Most often this is observed with pneumonia, tuberculosis and other pathological conditions. In addition, this condition can occur in acute heart failure. Crepitus in the lungs can be detected by listening to the respiratory organs.
• Bone crepitus - this pathological condition occurs when different bones are fractured, when sharp fragments rub against each other. Such sounds cannot be heard, but friction can be easily determined from an x-ray and based on the examination of the patient. Cracking in the joints may indicate second-degree arthrosis. This sound is different from the usual crunching sound that can sometimes occur and is normal. With arthrosis, the sound made by the bones is quite quiet.
• Subcutaneous crepitus is the rarest pathology, which, in other words, is called subcutaneous emphysema. A similar phenomenon occurs if individual air bubbles enter the subcutaneous layer. This pathology can occur with a complex fracture of the ribs, with pneumothorax, with severe damage to the bronchi, as well as with any other damage to the respiratory organs.

Only a doctor can determine the cause of tissue cracking based on the results of examining the patient, collecting an anamnesis and the results of some tests.

The rarest cause of cracking in subcutaneous tissues is considered to be anaerobic skin infections.

Crepitation of lung tissue

Most often, crepitating rales are heard in the lungs. A pathological sound is heard in the alveoli with strong inspiration. This is explained by the accumulation of fluid in the respiratory organs and the adhesion of pulmonary vesicles.

When a person inhales as deeply as possible, the lungs expand and the alveoli come apart, which is what causes a specific sound. At the same time, well-listened crepitus always has a peculiar explosive sound, very reminiscent of clicking sounds. The volume of such a sound depends on the total volume of the alveoli that have stuck together.

How to determine crepitus

It is very important to be able to distinguish crepitus in the lungs from other similar wheezes, since some of them are similar in sound. The main differences are:

• Crepitation is heard only in the alveoli, but fine rales are observed exclusively in the bronchi.
• Crunching is heard only with maximum inspiration, and wheezing can be heard both during inhalation and exhalation.
• Crepitus is always the same. It is explosive in nature, wheezing in the bronchi is more varied in its sound and has a more drawn-out character.
• The crunching sound after coughing does not disappear or change, and wheezing may disappear completely.

In addition, the doctor must be able to distinguish the crunching sound in the lung tissue from the specific friction noise that the pleura can make:

• The crunch is short-lived, and the friction produced by the pleura is quite long-lasting.
• Friction of the pleura can be heard both during inhalation and exhalation.
• At the very beginning of the disease, rubbing the pleura is very similar to rubbing your fingers near the ear. If the case is neglected, the friction resembles the creaking of a leather strap. Crepitation is always melodic and sonorous.
• When pressing with a stethoscope on the sternum, the friction of the pleura can be heard better, and the squeaks do not change at all.

If the patient holds his breath, then friction of the pleura is always audible. But there is no creaking of the lung tissue in this state.

With pulmonary tuberculosis, creaking is heard in the very top of the lungs. At the same time, the sounds are quite clear.

This phenomenon is observed extremely rarely, since it requires special damage to the airways. It is because of this pathology that air bubbles get under the skin and contribute to the appearance of crackling. There may be several reasons for the development of subcutaneous emphysema:

• Pneumothorax, with severe damage to the pleural leaves.
• Severe rib fractures, which injure lung tissue.
• Bullet and knife wounds of the respiratory organs.
• Ruptures of the respiratory organs in different areas.
• Damage to the esophagus.
• Anaerobic infections.

Quite often, air bubbles enter adjacent tissues, but they can spread throughout the body. In such a case, severe swelling of the tissue with periodic crepitus can occur in any part of the body.

This condition can quickly lead to infarction of important organs. If the pathological process is very widespread, then this indicates extensive damage to the lung tissue.

Crepitation of bone tissue

Such a crackling sound is characteristic of second-degree arthrosis. Crackling appears due to the fact that in some joints the interarticular fluid completely disappears. It is this fluid that lubricates the joints well and prevents friction. In the absence of fluid, the bones rub strongly against each other, wear out and become injured. If friction continues for a long time, characteristic bone growths appear on the joints.

At the first stage of the disease, no cracking is observed; in this case, the person is simply bothered by pain. And on last stage arthrosis, crepitus no longer has to be listened to, since the diagnosis can be made based on the results of examination of the patient. Usually, cracks are not heard in case of tissue fractures; in this case, the diagnosis can be made based on the results of an examination of the patient and an x-ray.

Crepitation of bone tissue often occurs with age-related changes in tissue, as well as with certain injuries.

Crepitus in tissues is not observed very often, but it has great diagnostic value. The more pronounced the sound, the greater the degree of tissue damage. This phenomenon should be distinguished from some other diseases.

Crepitation is a phenomenon that can be detected by listening (either with a phonendoscope or just with the ear, at a distance) or palpating; it looks like a crackling or light crunching sound. There are three types of crepitus: alveolar (it can only be heard with a phonendoscope), subcutaneous and bone (this crepitation is usually detected by palpating the affected area of ​​the body). All types of crepitus can only be identified by a doctor (alveolar - by a therapist or pediatrician, and subcutaneous and bone - by a traumatologist or surgeon), but patients should know what this or that type of crepitus indicates.

Alveolar crepitation

Alveolar crepitus refers to high-frequency pathological respiratory sounds. It can be heard by listening to the lungs with a phonendoscope, while alveolar crepitus has characteristic manifestations, reminiscent of the sound that occurs when kneading a tuft of hair near the ear with your fingers.

To listen to alveolar crepitus, the doctor presses the phonendoscope tightly to the skin, which reduces the audibility of low-frequency sounds, including sounds from the interaction of the skin with the membrane of the phonendoscope. If there is hair on the chest in the listening areas, then they are moistened with water or greased, since the friction of dry hair may simulate crepitus.

Crepitation is best heard at the height of inspiration (often only at the height of deep inspiration). It arises from the unraveling or straightening of the more moistened than usual walls of the alveoli (sacs at the ends of the smallest bronchi or bronchioles, which constitute the lung tissue) and is heard as a short sound “flash” or “explosion”.

Crepitus has a constant composition and a uniform caliber of sounds that does not change during breathing or after coughing. Sometimes it is difficult to distinguish crepitus from fine bubbly moist rales that occur when there is sputum in the small bronchi. But unlike crepitus, wheezing is often heterogeneous in caliber (as it occurs in bronchi of different diameters), is heard from the very beginning of inhalation, sometimes during exhalation, is longer in sound and often changes in quantity and caliber after coughing.

Sometimes crepitus resembles friction noise of the pleura during its inflammation (pleurisy). But the pleural friction noise is coarser in timbre, characterized by longer duration, audibility in both phases of breathing and a seemingly close sound (literally under the phonendoscope membrane).

Most often, alveolar crepitus is a sign of an acute inflammatory process in the lungs (pneumonia). It occurs during the phase of appearance and resorption of sputum (exudate) in the alveoli. In acute focal pneumonia with non-simultaneous inflammation of individual areas of the lungs, crepitus can be heard for several days. In case of lobar (with damage to an entire segment or lobe of the lung), it is heard only at the beginning of the disease, then disappears and appears again in the stage of resolution of pneumonia, when the exudate resolves. Crepitation can be heard for a long time in patients with damage to the alveoli due to systemic diseases connective tissue, for example, with systemic lupus erythematosus .

The mechanism of formation similar to crepitus is wheezing, heard during deep breathing over collapsed areas of the lungs in weakened people who have been lying down for a long time, especially in the elderly. Unlike true crepitus, wheezing from the expansion of collapsed areas of the lungs disappears after several deep breaths.

Subcutaneous and bone crepitus

Subcutaneous crepitus is a phenomenon that can be detected by palpation, hearing a characteristic crunching and crackling sound. The areas of the body that contain accumulations of free gas bubbles in the subcutaneous tissue are probed (palpated). Such phenomena are observed, for example, with gas gangrene, when an infection develops in the subcutaneous tissue without access to oxygen with the formation of gas. Air can get under the skin due to wounds (subcutaneous emphysema) and due to ruptures of hollow internal organs. Sometimes air is injected into various areas of the body for therapeutic purposes (for example, in the treatment of tuberculosis).

Bone crepitus is the sensation or sound of crunching from the mutual friction of fragments in the area of ​​the fracture. Such crepitus is usually detected during the process of palpating the fracture and can be heard at a distance.

Crepitus is serious diagnostic sign, which indicates that the patient requires urgent medical attention.

Galina Romanenko

Crepitation is a medical term used to describe a characteristic crunching sound that is detected by auscultation (listening) or palpation.

There are several types of crepitation:

• Alveolar. It is determined by auscultation of the lungs and resembles the sound that occurs when rubbing hair pinched between the fingers. This specific symptom of acute pneumonia accompanies the phases of formation and resorption of exudate in the alveoli and is heard as a series of “clicks” at the height of inspiration.
• Subcutaneous. It occurs during palpation or during auscultation when the head with the membrane is pressed on those areas of the body in which there are accumulations of gas bubbles in the subcutaneous tissue. This is a symptom of an anaerobic infection or subcutaneous emphysema.
• Bone. The crunching sound occurs when bone fragments touch each other. It is detected by palpation and auscultation and, as a specific symptom of a bone fracture, serves to diagnose fractures during the first examination of the victim.

There is also a kind of tendon crepitus, which occurs when a swelling is palpated in the area of ​​the tendon affected by tenosynovitis.

A crunching sound may also occur in the joints during movement. Crepitus in the joints is a characteristic symptom of osteoarthritis (osteoarthritis).

Causes

The main cause of the symptom is friction of body tissues, which is beyond the normal range.

Reason alveolar crepitus is the “unsticking” during inhalation of the alveolar walls, which stuck together during exhalation due to the presence of exudate, transudate or blood in the alveoli. This type of crepitus is heard:

• at stages I and III of lobar pneumonia, since at these stages of the disease the alveolar walls are saturated with exudate;
• in the presence of a pulmonary infarction, since the walls of the alveoli are saturated with blood;
• in the presence of congestion in the lungs, since the alveolar walls are saturated with transudate.

Crepitation in the lungs can also be heard with damage to the alveoli caused by systemic diseases(systemic lupus erythematosus, etc.).

Subcutaneous crepitus detected when:

• the presence of anaerobic pathogens (bacteria of the genus Clostridium, including tetanus bacillus, etc.);
• subcutaneous emphysema, which occurs during spontaneous ruptures of hollow organs containing air, and during injuries.

Subcutaneous crepitus is also detected in cases where gas is injected into various parts of the body for therapeutic or diagnostic purposes. The cause of this type of symptom is free gas bubbles accumulated in the subcutaneous tissue.

The cause of the bone type of symptom is the friction of bone fragments on early after the injury occurred. Bone crepitus in complex injuries can be combined with subcutaneous crepitus (rib fracture and lung rupture).

Crepitus, which occurs in the joints, is noted when:

• osteoarthritis, which occurs due to mechanical destruction of the normal structure of the joint and is accompanied by changes in the capsule and damage to the cartilage;
• rheumatoid arthritis;
• patellar dysfunction, etc.

Symptoms

The presence of crepitus may be a symptom of a life-threatening disease, but it is difficult to identify on your own. The symptoms accompanying crepitus depend on its location and the cause of its occurrence.

Crepitation in the lungs is accompanied by:

• bluish tint to lips and skin;
• pain in the chest area or a feeling of pressure;
• cough, shortness of breath, rapid breathing;
• vomiting or nausea.

Depending on the specific disease, hemoptysis, diarrhea, difficulty breathing, sweating, and loss of consciousness are possible.

A symptom of subcutaneous crepitus is swelling of the subcutaneous tissue.

Crepitation of bone fragments is accompanied by:

• pain in the area of ​​injury, aggravated by simulating axial load;
• dysfunction;
• swelling and hematoma, which do not appear immediately.

Possible pathological mobility or unnatural position.

Crepitus occurring in the joints is accompanied by:

• pain in the affected joints, increasing with exercise;
• rigidity (poor mobility) of the joints, which worsens after a state of rest;
• swelling in the joint area.

There may be a local increase in temperature, accompanied by redness of the skin.

Diagnostics

Crepitus in the lungs is heard using a phonendoscope at the height of inspiration (sometimes crepitus is heard only with a deep breath). The crunching sound is similar to a short sound “flash”, is constant in composition and does not change during breathing.

Crepitation may resemble fine bubble-like moist rales, which occur due to the presence of sputum in the small bronchi, but wheezing can be heard when listening both at the beginning of inhalation and sometimes during exhalation. In addition, wheezing can change in caliber and composition after coughing, but the sound of crepitus is not affected by coughing.

The sound may also resemble the noise that occurs when the inflamed pleura rubs. With pleurisy, the difference between the noise is its longer duration, closer sound and audibility both during inhalation and exhalation.

Similar to crepitus and wheezing, which occur in the area of ​​collapsed areas of the lungs in weakened people during deep breathing, but they disappear after a series of deep breaths.

Subcutaneous crepitus is diagnosed by palpation.

The bone type of symptom is detected by palpating the fracture site (the sound is often heard at a distance).

Joint crepitus is diagnosed by palpating the joint and taking into account the patient's complaints, and its cause is determined using x-ray examination.

Treatment

Since crepitus is not a disease, but a symptom of a disease, it cannot be treated. This symptom can only be eliminated by treating the pathology that caused it. Treatment is prescribed by the doctor depending on the type of disease.

Types of wheezing with pneumonia

Wheezing is a noise that occurs in the chest and is heard when breathing. This phenomenon occurs when an obstacle is encountered in the path of the air flow passing through the respiratory tract. Completely normal healthy person no noise is detected. They usually appear in diseases of the respiratory organs. What are the types of wheezing with pneumonia and what are their characteristics?

Types of wheezing

There are several types of wheezing that can be heard during pneumonia:

• crepitus;
• wet;
• dry;
• pleural friction noise;
• bronchophony.

Crepitus

During pneumonia, the alveoli fill with fluid. When the breathing process occurs, they periodically stick together and come apart, making a quiet sound. This phenomenon often occurs at the very beginning of the development of pneumonia, as well as during recovery. This sound resembles a light crackling sound and is heard only when inhaling.

Crepitation can be detected by listening to the lung using a phonendoscope. The doctor presses it tightly against the patient’s skin, thereby reducing the audibility of low-frequency sounds. If the patient is a man and has hair on his chest, it is necessary to lubricate this area with fat so that imitation crepitus does not occur when rubbing dry hair.

Crepitation can be congestive and inflammatory. The first type is usually observed in the lower pulmonary regions. This kind of crepitation is less sonorous than inflammatory. In the latter case, compacted tissue is found around the alveoli, which is better able to conduct sound.

Wet wheezing

This type of wheezing can be fine-bubble, large-bubble or medium-bubble. It all depends on the involvement of small, medium or large bronchi in the process. They accumulate fluid that forms during inflammation. It is called exudate. When you breathe, the liquid gurgles. Moist rales are heard in both phases of breathing.

If pneumonia goes away without complications, fine bubble noises are often observed. They sound like small bubbles bursting. When pneumonia is complicated or advanced, coarse wheezing occurs. The sound can be heard not with the help of a special device, but even at a short distance from the patient. Medium-bubble noises occur when the lung edema, fluid enters the small or medium bronchi. They sound like crackling.

Dry wheezing

This type of noise occurs when the air passing through the bronchi does not find an obstacle, which is liquid. Dry wheezing appears at the beginning of the development of pneumonia, which occurs against the background of other diseases of the respiratory system, such as, for example, bronchitis. They are observed in both phases of breathing and sound like rustling.

During the course of the disease, bronchial obstruction sometimes occurs. This often occurs in patients suffering from bronchial asthma. At the same time, a whistling sound is heard. The air stream passes through the bronchi, as if through a pipe. This sound is easy to hear without special equipment.

Dry noises indicate a narrowing of the lumen in the bronchi.

This occurs due to tumors, swelling of the mucous membrane, and the presence of lumps of viscous sputum.

Pleural friction rub

If another disease, dry pleurisy, is associated with pneumonia, a pleural friction noise appears. It resembles scraping sounds and is similar to crepitus. However, such noise is heard constantly, in both phases of breathing. It appears when the inflamed layers of the pleura rub against each other under the influence of air flow.

Pleural friction noise is characterized by the following properties:

• dry intermittent sound;
• superficiality of noise felt close to the ear;
• variability of sound (can appear and disappear) - the exception is chronic form illness;
• low sound prevalence;
• heard in both phases of breathing;
• presence of pain.

Typically, a pleural friction rub is found in the lower part of the chest, on the side. Sometimes it is difficult to distinguish it from wet wheezing. In this case, you need to know some nuances. First, when applying pressure with a stethoscope, the pleural noise becomes louder. As for coughing and deep breaths, the sound does not change or disappear.

Bronchophony

Bronchophony is the strengthening of the patient's head when listening to the lungs. At the same time, he pronounces the word in a whisper, and the doctor hears him perfectly. If bronchophony is pronounced, there is also a metallic tint to the sound. This type of noise indicates compaction in the lungs, which appeared as a result of inflammatory infiltration or for other reasons. With bronchophonia, vocal tremors are often detected.

Murmurs due to complications of pneumonia

Pneumonia can cause complications. In this case, wheezing may remain for a long time. Complications accompany patients with weakened immunity and chronic illnesses. Thus, symptoms may recur. A person begins to cough and their body temperature rises. When you go to the hospital, your doctor will listen for noises in your lungs.

They can be caused by the following groups of complications:

1. Pulmonary - adhesions, pulmonary fibrosis, abscess, gangrene, pleural empyema.
2. Extrapulmonary.

Murmurs due to pulmonary complications

With pneumonia, adhesions can form in the pleural area. When they stretch and rub against each other, a pleural friction noise occurs. After the inflammatory process, the lung tissue is replaced by fibrous tissue and also becomes denser. As a result respiratory organ has less mobility. At the same time, moist fine-bubbling and dry crackling noises are heard. Voice tremors are observed.

With pneumonia, an abscess may develop as a complication, which is inflammatory with purulent contents. At the same time, the temperature rises and weakness is felt. Sometimes trembling is heard in the voice, and moist wheezing occurs. After opening the abscess, a cavity remains in the lungs. At the same time, signs of amphoric breathing are added.

Sometimes pneumonia is complicated by gangrene. It is a putrefactive formation that is localized over large areas of the organ. In this case, the patient's condition deteriorates sharply, and wet noises are noted during breathing.

Pleural empyema is an inflammatory process on the layers of the pleura of a purulent nature. They sometimes spread to the lung tissue. At the same time, moist wheezing is heard.

Murmurs due to extrapulmonary complications

This type of complication can lead to cardiopulmonary failure. This is expressed by stagnation of blood in the vessels. The patient feels a lack of air and a rapid heartbeat. Wheezing is heard in the lower sections.

Accompanying symptoms

In addition to wheezing, pneumonia causes shortness of breath, cough with sputum, chills, general weakness, and voice tremors. The temperature rises to 39.5 degrees, but may remain low. Blood streaks are sometimes visible in the sputum. A characteristic sign of pneumonia is chest pain. Usually pain is felt when trying to breathe. Moreover, it is localized precisely in those areas of the lungs where the focus of inflammation develops. Conceptual pain manifests itself when pleural pneumonia occurs.

As for cough, it is not related to characteristic symptoms. The infection can be localized not near the main respiratory tract, but far from it. The disease may be accompanied by headaches and fever. Sometimes the patient loses consciousness, and the color of the skin changes.

Auscultation of the lungs

Auscultation is a way of listening to noises. Identifying wheezing, determining its nature, as well as its exact signs - all this is part of the task of this procedure. Auscultation of the lungs is carried out in different positions of the patient. All segments of the chest are heard in turn, both on the right and left sides.

When performing lung auscultation, different breathing modes are used. This makes it possible to identify noises before and after coughing, when pronouncing certain sounds, or taking medications.

For the purpose of further research, the caliber, tonality, timbre, sonority, prevalence, uniformity, and amount of noise are taken into account.

Pneumonia is a disease accompanied by a large number of symptoms, which include cough, fever, voice tremors and others. Very often this insidious disease is accompanied by wheezing that occurs when breathing. Depending on the course of the disease, the location of the source of inflammation, associated complications and other nuances, noises may vary. It is the task of medical workers to establish their nature. The correct diagnosis depends on this, and, accordingly, effective treatment.

Characteristic wheezing in pneumonia

For pneumonia, the main method of clinical diagnosis is auscultation, that is, listening to the respiratory organs. Having practical experience and knowing what wheezing can accompany pneumonia, the doctor can easily make a diagnosis and begin treatment even before receiving data from laboratory and instrumental examination methods.

First you need to know the places of auscultation and the rules of listening to the lungs, and listen to the sound of normal vesicular breathing to distinguish it from pathological ones.

Places and sequence of listening to the lungs, front and back views.
Rules for listening to the patient's lungs.

What causes wheezing during pneumonia?

Normally, in a healthy person in a calm state, you can hear quiet, even breathing on auscultation, which is called vesicular.

Wheezing is the noise that occurs in the chest when breathing during pneumonia. The inflammatory process in the tissues of the lungs causes swelling of the bronchi and alveoli, and the air flow hardly passes through narrow areas, creating a characteristic noise or wheezing that the doctor hears when listening. Unusual sounds in the chest can be heard by the patient himself and by strangers at a distance.

Types of wheezing with pneumonia

Pneumonia is accompanied by noises in the lungs when breathing that are uncharacteristic for a healthy person. Wheezing during pneumonia will depend mainly on the stage of the disease and the extent of the process in the lung tissue.

1. Wet wheezing.
2. Dry wheezing.
3. Crepitus.
4. Pleural friction noise.
5. Bronchophony.

At the same time, the doctor can hear different types wheezing.

Wet wheezing

Moist rales are a sign that there is liquid exudate in the bronchi, and as air passes through it, the liquid begins to gurgle; when listening, it seems as if bubbles are bursting. Moist rales can be heard through a phonendoscope, but sometimes they can be heard at a distance. They are detected in both phases of breathing - inhalation and exhalation.

Types of moist rales can be small-bubble, medium-bubble, or large-bubble.

This character is obtained depending on which bronchi are affected by the process - with a narrow lumen, medium or wide. During the inflammatory process, the bronchi are filled with exudate or, more simply, sputum, of varying degrees of viscosity, which prevents the movement of air through respiratory tract and creates a characteristic gurgling sound. The sounds are often intense and loud. When changing body position or coughing, wheezing disappears for a while, then reappears. The intensity of wheezing usually increases before a coughing attack followed by the release of a large amount of sputum. Then the breath is clear for some period of time.

Moist rales appear 2-3 days after the onset of the disease and disappear no earlier than a week and a half after sputum ceases to be produced by the bronchial mucosa and clinical recovery.

Fine bubble wheezing can be heard in the initial period of the disease and later during recovery, as well as a favorable course of pneumonia, without complications.

Dry wheezing

The source of dry wheezing is the bronchotracheal tree. Wheezing can be heard on inhalation and exhalation.

Dry wheezing appears at the beginning of the disease, after the bronchial mucosa has swollen, their lumen has decreased in diameter, but there is no exudate or there is a small amount of thick secretion. The air, passing through such narrow bronchi, creates multi-tonal long sounds, reminiscent of howling and whistling. After coughing, the characteristics of the sounds may change.

Such wheezing can only be heard through a phonendoscope, but in severe cases with bronchial obstruction (blockage of the bronchi), the patient himself can hear high-pitched sounds, similar to a weak squeak in the last phases of inspiration.

Crepitus

Crepitation is a sound similar to a dry cracking sound or the creaking of snow underfoot. This type of noise is formed in the alveoli, which are located at the ends of the bronchi. Alveoli look like small bubbles, participate in the act of breathing, and gas exchange occurs in them.

Normally, the alveoli contain a small amount of fluid necessary for lubrication. The inflammatory process changes the quality of the exudate, it acquires a different consistency, changes properties, as a result the walls of the respiratory sacs collapse and stick together. Involved in inflammatory process the alveoli begin to open not as usual at the beginning of inhalation, but at the end, sharply, with a sound reminiscent of a crackling sound.

This noise can only be heard when inhaling. Coughing and changing body position do not change the nature of the sound.

Crepitus appears early, often on the next day of illness, and slowly disappears during the period of clinical recovery.

Pleural friction rub

A sound resembling rubbing of palms can be heard if pneumonia is complicated by pleurisy. In this case, the serous membrane of the lungs, the pleura, consisting of two layers, internal and external, is involved in the inflammatory process. When there is inflammation from the pleural cavity, which is located between the leaves, the normal fluid leaves, their surface becomes dry and rough, during breathing movement the leaves rub against each other, a rustling sound is heard.

The noise is heard in both phases of breathing.

Coughing does not change the nature of the sound; the cough may disappear when changing body position, in the case when the leaves are pressed against one another.

Bronchophony

Method of listening to the patient's voice. This method is used when there is a suspicion of compaction of lung tissue due to the presence of an inflammatory infiltrate in the lung tissue. This method helps to establish the localization of the pathological process by comparing different places in the chest.

To do this, the patient is asked to whisper words containing the letter - h. Usually the phrase “cup of tea.”

In people with healthy lungs, spoken words cannot be understood. In case of pneumonia, as a result of compaction of the conductive medium, the patient’s words and voice can be clearly heard through a phonendoscope.

Can you have pneumonia without wheezing?

Yes, asymptomatic pneumonia occurs in weakened patients and children; in this form there is no cough, fever, or wheezing in the lungs. The latent form complicates diagnosis and worsens the prognosis. In this situation, you need to pay attention to additional symptoms and appearance patient.

Symptoms of latent pneumonia:

• general weakness, unreasonable fatigue, shortness of breath, dizziness;
• pain in the chest, worsening with a deep breath;
• the skin acquires a gray tint, but with a blush on the cheeks or a blue tint to the nasolabial triangle.

In such cases, you need to focus on additional signs of the disease, blood tests, sputum tests, and chest x-rays.

Reasons for the absence of wheezing and other symptoms characteristic of pneumonia:

• if during pneumonia the focus of inflammation is in the lower lobes of the lungs;
• in patients with weakened immunity;
• in those who often uncontrollably take antibacterial or hormonal drugs.

How long does it take to hear wheezing after pneumonia?

Crepitus can be heard in the initial and final stages of the disease.

Dry and moist wheezing is detected throughout the entire period of illness and after recovery for up to 2-3 weeks, at which time the bronchi are freed from sputum. If pneumonia is complicated by pleurisy, the noise of rubbing layers of the pleura will be heard.

Pneumonia is a serious disease, so at the first signs and wheezing in the chest you should definitely consult a physician. After all, any pathology is easier to cure at the initial stage.