PLEURAL FRICTION RUB

MARCIAL JOURNAL
● Is a creaking, leathery, or grating sound produced when the two ● Nonmusical and explosive
layers of an inflamed and/or thickened pleura rubs together during ● Normally, the parietal and visceral pleura slide over each other
breathing silently
● Usually heard during inspiration and expiration ● In lung diseases, the visceral pleura becomes rough enough that it
● Rub is often well-localized and audible throughout the respiratory produces crackling sounds heard as a friction rub
cycle ● More prominent on auscultation of the basal and axillary regions
● Sometimes mistaken for crackles than the upper regions
● Gritty leathery quality of the sound and the consistency of this ● Upper regions lie on the flat portion of the static pressure-volume
quality help in differentiating pleural friction rub from crackles curve
● Coughing and deep breathing may also help in distinguish pleural ● Basal regions lie on the steep portion of the curve and undergoes
friction rub from crackles greater expansion in changing transpulmonary pressure
● Presence of symptoms of pleurisy should also be sought to help ● Typically biphasic with the expiratory sequence of sounds mirroring
distinguish the 2 kinds of sounds the inspiratory sequence
● Pleural friction rub is also sometimes mistaken for pericardial friction ● Sound Analysis: Waveform is similar to crackles except for its
rub. longer duration and lower frequency
● Mechanism: Probably produced by the sudden release of
Table 1. Pleural Friction Rub VS Pericardial Rub tangential energy from a lung surface that is temporarily prevented
Pleural Friction Rub Pericardial Rub from sliding because of friction between the two pleural layers
Leather quality ● Typically heard in inflammatory diseases (e.g. pleuritis) or
May be found anywhere Localized in the left parasternal malignant pleural diseases (e.g. mesothelioma)

inflammatorydiseasesent messinelon
where there is pleura region, in the 2nd or 3rd ICS see
Disappears during breath- Persists during breath-holding AUSCULTOGRAM
holding
Has 3 intermittent scratching
components that coincide with
systole and diastole
→ Atrial systole
→ Ventricular systole
→ Ventricular diastole
● Representation in Lung Auscultogram:
→ Open circle with a cross to represent the gritty scratchy quality
of the sound
→ Arrow to where the sound was heard connects the illustration
with the chest Figure 12. Lung Auscultogram of a Pleural Friction Rub

MIXED SOUND (SQUAWK)

MARCIAL
● Rarely described and appreciated sound
● Described in patients with interstitial fibrosis and allergic alveolitis
● The sound is made up of a short inspiratory wheeze that is usually
preceded by crackling sounds.
● Representation in Lung Auscultogram:
→ Short wavy line (as in wheeze)
▪ Preceded by small solid dots (as in fine crackles)
AUSCULTOGRAM
JOURNAL
● Also called “short wheeze” or “squeak”
● Mixed = contains short musical and nonmusical components
accompanied/preceded by crackles
● Sound Analysis in Hypersensitivity Pneumonitis: Appears as
sinusoidal oscillations that are less than 200 msec with a
fundamental frequency between 200-300 Hz
● Mechanism: Not entirely known
→ According to one theory, produced by oscillation of the peripheral
airways (in deflated lung zones) whose walls remain in
apposition long enough to oscillate under the action of the
inspiratory airflow
● Typically heard from the middle to the end of inspiration in
interstitial diseases, especially hypersensitivity pneumonitis
but NOT pathognomonic
● Also documented in bronchiectasis and pneumonia
● Pneumonia is most likely the next cause if there is no evidence of
interstitial disease

Figure 13. Lung Auscultogram of a Squawk

MED.3.08 TBL: Lung Sounds 8 of 26