Rales

Introduction The rales are adventitious sounds other than breath sounds. Normal people usually have no arpeggios, so non-breathing sounds change. According to the nature, it can be divided into the following types. The characteristics of moist rales: wet muzzle is an additional sound outside the breath sound, continuous and short-lived, often appearing continuously multiple times, more obvious when inhaling or inhaling, sometimes appearing in exhalation Early. The part is relatively constant, the nature is not easy to change, and the medium and small blisters can exist at the same time, and can be alleviated or disappeared after coughing. The characteristics of dry voice: dry voice is a kind of breath sound with longer duration and higher tone. The pitch is about 300 ~ 500Hz. It lasts longer and can be heard when inhaling and exhaling. It is obvious when exhaling. The intensity and nature of the dry voice are easy to change, the parts are easy to change, and the number can be significantly increased or decreased in an instant. The dry sound that occurs above the main bronchus can sometimes be heard without a stethoscope.

Cause

1, dry voice: seen in the tracheobronchial inflammation, stenosis and stenosis, bilateral extensive dry snoring found in bronchial asthma, chronic bronchitis, cardiogenic asthma, hay fever, cotton pneumoconiosis, etc., limitations, regular Dry sputum is seen in endobronchial tuberculosis, early stage lung cancer, bronchial pneumonia, etc.

2, wet voice: seen in bronchopulmonary disease and various causes of left heart failure, pulmonary edema. The limitations of the lungs, fixed wet voice, suggest local lesions, such as lung inflammation, tuberculosis, pulmonary infarction, bronchiectasis, lung abscess, secondary infection of lung cancer. The wet voice of the lungs on both sides of the lungs is seen in cardiac dysfunction leading to pulmonary congestion, bronchitis, bronchial pneumonia, and idiopathic pulmonary interstitial fibrosis. Bilateral extensive wet voice, seen in acute pulmonary edema, chronic bronchitis. Pneumonia has a large blisters, or a fixed small wet voice in the interscapular region, more common in tuberculosis.

mechanism

1, dry voice

It is a long-lasting breath-attached sound that is caused by turbulence caused by stenosis or partial obstruction of the trachea or bronchi. The pathological basis of the occurrence is trachea, inflammation on the bronchial wall, congestion and swelling of the mucosa of the mucosa, increased secretion, bronchial smooth muscle spasm, tumor invasion in the lumen, partial obstruction of foreign bodies or secretions, or swelling of the wall by enlarged lymph nodes. And narrow. Arpeggio, the lesion mostly occurs in the trachea or the main bronchus. If the snoring is caused by mucus retention, it will disappear after coughing. Local fixed snoring will indicate bronchial obstruction. If repeated vocalization occurs in the same site, it should consider mucus stenosis caused by bronchial stenosis. The snoring caused by the long-term retention of bronchospasm is bilateral. The whistle is a high-pitched dry sound, often described as wheezing, flying arrow, bird sounds, etc., lesions mostly occur in the bronchi or bronchioles.

2, wet voice

That is, the bubbling sound is due to the thinner liquid in the trachea or bronchi, such as exudate, sputum, blood, mucus, purulent, etc., the sound produced by the rupture of the bubble formed by the gas passing through the liquid during breathing. It occurs more frequently when inhaling, or more clearly at the end of inhalation, and sometimes in early exhalation, where the site and nature are relatively constant. Due to the large diameter of the bronchial lumen of the lesion, or the size of the cavity, the amount of fluid is different. The sound of the wet squeak is thick, medium, and fine, or called large, medium, small blisters, and the bottom of the lung when inhaling. The sudden opening of the small airway alveolus in the airless area can produce an "aspirating popping sound". The early popping sound of the inhalation indicates a severe obstructive pulmonary disease, and the late inspiratory cracking sound can also be used in the elderly or long-term bedridden patients. After a long period of shallow breathing, the bottom of the abdomen is suddenly inhaled. This is because the small airway at the bottom of the lung is open later, and does not necessarily indicate pathological conditions.

an examination

Related inspection

Bronchial provocation test (BPT) fiberoptic bronchoscopy lung diffusion function test (DL) bronchodilation test lung ventilation function

Dry voice characteristics

The adjustment is high, the music is good, the duration is long, and the inhalation and exhalation can be heard, but the exhalation is obvious, the voice is emphasized, the nature and the part are changeable, and the number can be significantly increased or decreased in an instant. The dry sound that occurs in the atmosphere, sometimes can be heard without a stethoscope, which means wheezing.

Wet voice characteristics

In addition to the size, loudness, quantity, and dynamic changes of the dehumidification sound, attention should be paid to the distribution of wet sounds. The wet voice is limited, suggesting local lesions.

Such as pneumonia, tuberculosis, bronchiectasis, etc.; wet voice is located at the bottom of both lungs, more common in heart failure, pulmonary congestion, bronchial pneumonia, etc.; such as wet sputum full of two lungs, more common in acute pulmonary edema and severe bronchial pneumonia.

Differential diagnosis

Identification of wet squeak and pleural friction

In dry pleurisy, the surface is rough, and the sound produced by the friction between the wall layer and the visceral pleura during respiration is the pleural friction sound. It is easy to be confused with the wet sputum during auscultation. The pleural friction sound can be heard during exhalation and inhalation. When you hold your breath, the sound is often clear when you take a deep breath or pressurize. The palpation has a pleural friction. The cough cannot change other properties often accompanied by chest pain. The wet squeaky sound often appears when inhaling, or at the end of inhalation. Clear cough can sometimes disappear, and the two are identified.

Identification of wet squeak and pericardial friction

In pericarditis, the surface of the pericardium and the visceral medulla are rough. During the process of cardiac relaxation, the two layers of inflamed pericardium rub against each other to produce sound. The pericardial friction is sometimes similar to pleural friction and wet squeak, while pericardial friction occurs with the heart. The activity is consistent, and there is also no breath holding when breathing. It can be heard from systolic to diastolic, sometimes only during systole, usually the 3.4th rib sound is the clearest on the left sternal border. These are all characteristics, so Identification with wet voice.

Identification of wet sputum and subcutaneous emphysema

When there is subcutaneous emphysema in the chest, you can hear a similar hair in the auscultation, which is like a wet voice, but this sound can be heard both during exhalation and inhalation. When the hand is pressed, the gas moves in the lower tissue. The position can also form a sound, like a feeling of hair or a sense of snow, subcutaneous emphysema can spread from the chest wall to the neck, abdomen, upper limbs, etc., so it is distinguished from the wet voice.

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