Pleural friction

Introduction The normal pleural surface is smooth, and there is a trace of liquid in the pleural cavity. Therefore, there is no acoustic occurrence when the pleural visceral layer and the wall layer slide between each other during breathing. However, when the pleural surface becomes rough due to inflammation and cellulose exudates, pleural friction sounds may occur as the breath progresses. The patient conceals the nose and strengthens the abdominal movement. At this time, although there is no airflow in and out of the airway, the pleural friction sound can be heard, which can be distinguished from the sputum pronunciation. The most frequently heard part of the pleural friction sound is the anterior inferior chest wall, which has the greatest respiratory mobility.

Cause

Causes of pleural friction: The most frequently heard site is the anterior inferior chest wall, which has the greatest respiratory mobility. Common in cellulosic pleurisy, pulmonary infarction, uremia, pleural tumor, a small amount of pleural effusion, severe dehydration and other diseases.

1 pleural inflammation: such as tuberculous pleurisy, suppurative pleurisy and other causes of pleural inflammation.

2 primary or secondary pleural tumors.

3 pulmonary lesions involving the pleura: such as pneumonia, pulmonary infarction.

4 The pleura is highly dry: such as severe dehydration.

5 other: such as uremia.

an examination

Related inspection

Chest MRI

It is characterized by the sound that is heard with one hand covering the ear and rubbing with the other finger on the back of the hand. The pleural friction sound is usually heard in both phases of the breath, and it is very close to the ear. It is usually more obvious at the end of inhalation or at the beginning of exhalation, and disappears when the breath is held. The intensity of the rubbing sound can be increased when breathing deeply or by pressing on the body of the stethoscope.

The most frequently heard part of the pleural friction sound is the lower chest wall of the midline. The pleural friction sound can disappear or reappear as the body position changes. When there is more pleural effusion, the friction sound can disappear because the two layers of pleura are separated, and it can reappear when the two pleuras are in contact again during the absorption of the effusion.

Differential diagnosis

Differential diagnosis of pleural friction sound:

The patient takes a sitting position or a lying position. The examiner uses a stethoscope to auscultate the chest and hears a frictional sound. The sound properties vary greatly. Some sounds are soft and subtle. For example, the friction of silk fabrics is very rough. Some sounds are rough, such as squeaking, rustling, snowing or snow-holding. Friction sounds can appear in a very short time. Disappearing or reappearing can last for a few days or more. Both exhalation and inhalation can be heard. Generally, it is more obvious at the end of inhalation and at the beginning of exhalation. When the breath is held, the sound disappears, and when the breath is deep, the sound is enhanced, which can be distinguished from the pericardial friction sound. At the same time, the patient can cover the nose and strengthen the abdominal movement. At this time, although there is no airflow in and out of the airway, the pleural friction sound can be heard, which can be distinguished from the . The most frequently heard part of the pleural friction sound is the anterior inferior chest wall, which has the greatest respiratory mobility. Conversely, the pulsation of the tip of the lung is smaller than the lower part of the thorax, so the pleural friction sound is rarely heard at the tip of the lung. The pleural friction sound can disappear or reappear as the body position changes. When there is more pleural effusion, the friction sound can disappear because the two layers of pleura are separated. When the two layers of pleura approach, during the absorption of pleural effusion, it can reappear. When the mediastinal pleural inflammation occurs, the friction sound can be heard with the breathing and the heart beat, called the pleural pericardial friction sound. When you hear the pleural friction, you can consider the lesions in the lungs and pleura.

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