Crepitations in Chest Examination

Crepitations in Chest Examination


Definition: Crepitations, also known as crackles, are abnormal lung sounds heard during auscultation using a stethoscope. They are typically associated with various pulmonary conditions and occur due to the presence of fluid, mucus, or fibrosis within the alveoli and small airways.

Types of Crepitations:

  1. Fine Crepitations:

    • Soft, high-pitched, and brief.
    • Heard predominantly at the end of inspiration.
    • Commonly associated with interstitial lung diseases (e.g., pulmonary fibrosis) and early stages of pulmonary edema.

  2. Coarse Crepitations:

    • Louder, lower-pitched, and longer in duration.
    • May be heard during both inspiration and expiration.
    • Often seen in bronchiectasis, chronic bronchitis, and later stages of pulmonary edema.

Mechanism:

  • Crepitations are produced by the sudden opening of small airways and alveoli that have been collapsed or filled with fluid. As air moves through these areas during inspiration, the airways pop open, causing the characteristic sound.

Clinical Significance:

  • Crepitations can be an important indicator of underlying lung pathology:
    • Pulmonary Edema: Fine crackles at the lung bases are a classic finding.
    • Interstitial Lung Disease: Fine, dry crackles are frequently heard in the early stages.
    • Bronchiectasis: Coarse, moist crackles are heard due to mucus accumulation.
    • Pneumonia: May produce coarse crepitations over the affected lobes.

Auscultation Technique:

  • Ask the patient to sit upright and breathe deeply through their mouth.
  • Use the diaphragm of the stethoscope to listen over the posterior chest, comparing both sides.
  • Crepitations are most commonly heard at the lung bases, but the location may vary depending on the underlying condition.

Diagnosis and Further Evaluation:

  • Presence of crepitations prompts further diagnostic workup, such as chest X-ray, CT scan, and pulmonary function tests, to identify the cause.

Key Conditions Associated with Crepitations:

  • Pulmonary edema
  • Interstitial lung diseases (e.g., idiopathic pulmonary fibrosis)
  • Pneumonia
  • Chronic obstructive pulmonary disease (COPD)
  • Bronchiectasis
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