Pulmonary rales

Introduction The dry and wet voice of the lungs indicates respiratory diseases. Like other systemic diseases, careful detailed medical history and physical examination are the basis for diagnosing diseases. X-ray chest examination has a special important role in respiratory diseases. Because respiratory diseases are often a manifestation of systemic diseases, comprehensive comprehensive analysis should be performed in combination with routine tests and other special examination results, in order to make a diagnosis of etiology, anatomy, pathology and function. The same is true for dry and wet voices in the lungs.

Cause

The dry voice is caused by stenosis of the trachea, bronchi, or bronchioles due to stenosis or incomplete obstruction, and inhalation or exhalation of airflow. Its pathological basis is inflammation-induced mucosal congestion and edema, increased secretion, bronchial smooth muscle spasm; intracavitary foreign body, tumor obstruction and enlarged lymphatic or mediastinal compression airway.

Localized wet sputum sounds in the lungs only suggest local lesions such as pneumonia tuberculosis or bronchiectasis. The wet sounds of the lungs on both sides are more common in pulmonary blood stasis and bronchial pneumonia caused by heart failure, such as the two lungs. Wet snoring is more common in acute pulmonary edema or severe bronchial pneumonia.

According to the sound intensity of the voice, it can be divided into two types: loudness and non-resonance:

(1) Luminous wet voice: sound is bright, because of the surrounding good media, no consolidation, or the result of cavity resonance, seen in pneumonia, lung abscess or hollow tuberculosis. If the inner wall of the cavity is smooth, the loud and wet sound can also be accompanied by a metal tone.

(2) Non-resilent wet voice: The sound is low, because there are more normal alveolar tissues around the lesion, the sound waves are gradually weakened during conduction, and the auscultation is far away.

According to the size of the airway cavity diameter and the amount of exudate in the cavity, the coarse, medium and fine wet voices and sputum pronunciation:

(1) coarse crackles: also known as large blisters, occurring in the trachea, main bronchus or hollow parts, mostly in the early inhalation. Found in bronchiectasis, pulmonary edema, tuberculosis or lung abscess cavity. Patients who are comatose or sudden death are unable to discharge respiratory secretions, and can hear thick and wet voices at the trachea.

(2) Medium crackles: Also known as medium-bubble sounds, which occur in medium-sized bronchi, mostly in the middle of inhalation, found in bronchitis, bronchial pneumonia, etc.

(3) fine crackles: also known as small blisters, occurring in the small bronchi, mostly in the late inhalation. Common in bronchiolitis, bronchial pneumonia, pulmonary congestion and pulmonary infarction. In patients with diffuse pulmonary interstitial fibrosis, the fine wet voice that appears in the late inhalation has a high pitch, and the near ear is similar to the sound produced when tearing the nylon buckle, which is called Velcro.

(4) (crepitus): is a very fine and uniform wet voice. I heard it at the end of inhalation, quite like the sound of a bunch of hair with my fingers in my ear. This is because the bronchioles and alveolar walls adhere to each other due to the presence of secretions. When inhaling, they are re-inflated by the airflow, and the high-pitched, high-frequency fine pops are emitted. Common in bronchioles and alveolar inflammation or congestion, such as pulmonary congestion, early pneumonia and alveolitis. However, in normal elderly or patients who are in bed for a long time, they can also hear the sputum at the bottom of the lungs. They can disappear after several deep breaths or coughs, and generally have no clinical significance.

an examination

Related inspection

Chest CT examination chest B-ultrasound

1, dry voice: high, happy, long duration, inhalation, exhalation can be heard, but with exhalation is obvious, voice emphasis, nature, location is variable, the number can be significantly increased in an instant Less. The dry sound that occurs in the atmosphere, sometimes can be heard without a stethoscope, which means wheezing.

2, wet voice: auscultation characteristics are intermittent and short-lived, often appear in succession multiple times, inhalation or inhalation end is more obvious, and sometimes appear in early exhalation. The part is relatively constant, the nature is not easy to change, and the medium and small wet voices can exist at the same time, and can be alleviated or disappeared after coughing.

Differential diagnosis

1. Double lung blisters: Also known as wet squeaky sound, it is the sound produced by the gas passing through the thin secretions in the respiratory tract during inhalation. According to the size of the airway cavity and the secretion, it is divided into large, medium and small blisters. sound. Large blisters are more common in patients with bronchiectasis, tuberculosis, pulmonary edema, and coma; medium and small blisters are found in bronchial pneumonia, chronic bronchitis, and pulmonary interstitial fibrosis.

2. Inspiratory burst sound of both lungs: Alveolar-capillary block syndrome is a group of symptoms in which the alveolar-capillary wall of the gas diffusion surface is lesioned and the oxygen diffusion capacity is reduced. Typical signs are mainly inspiratory bursts and clubbing of both lungs. In addition to the clinical manifestations of the primary disease, the following common characteristics: the incidence of the disease is slower than the hidden. Progressive breathing difficulties, followed by varying degrees of cyanosis, breathing shallow and fast. After a long illness, clubbing (toe, cough, a small amount of cough, fever, weight loss, etc. may occur in the late stage of right heart failure. Typical signs are mainly inhalation pops and clubbing of both lungs.

3, pulmonary stenosis murmur: long-term pulmonary stenosis will cause the main pulmonary artery and left pulmonary artery to significantly expand, when the blood from the right ventricle to spray the human expansion of the pulmonary artery, it will produce turbulence and oscillation, thus forming a noise. The murmur is typical of systolic murmur, rough, strong hair is above 3/6, often accompanied by tremor and P2 weakened.

4, pulmonary murmur: divided into systolic murmur and diastolic murmur. Pulmonary artery murmurs generally indicate pulmonary artery malformation or pulmonary regurgitation, pulmonary regurgitation and other factors.

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