Fremitus
| Fremitus | |
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| Classification and external resources | |
| DiseasesDB | 13981 13982 |
Fremitus is a palpable vibration on the human body.[1] In common medical usage, it usually refers to (tactile) vocal fremitus, although there are several other types.
Contents
Respiratory
Pleural fremitus
Pleural fremitus is a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs. See pleural friction rub for the auditory analog of this sign.
Rhonchal fremitus
Rhonchal fremitus, also known as bronchial fremitus, is a palpable vibration produced during breathing caused by partial airway obstruction. The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. See rhonchus (rhonchi) for the auditory analog of this sign.
Subjective fremitus
Subjective fremitus is a vibration felt by the patient on humming with the mouth closed.
Tactile fremitus
Tactile Fremitus, known by many other names including pectoral fremitus, tactile vocal fremitus, or just vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat a phrase while the examiner feels for vibrations by placing a hand over the patient's chest or back. Phrases commonly used in English include 'ninety-nine', 'boy oh boy', 'toy boat', and 'blue balloons' (these are all dipthong phrases).
Tactile fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial bifurcation. Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (where there is liquid or air instead of usual lung).
The reason for increased fremitus in a consolidated lung is the fact that the sound waves travel faster through a solid (the consolidation) than a gas (aerated lung). Conversely, the reason for decreased fremitus in a pleural effusion (or any pathology separating the pleura), is that this increased space between the pleura acts as a barrier to the sound waves.
It has recently been suggested that the artifacts caused by eliciting tactile fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors.[2]
Tussive fremitus
Tussive fremitus is a vibration felt in testicles when coughing
Other
Hepatic fremitus
Hepatic fremitus is a vibration felt over the patient's liver. It is thought to be caused by a severely inflamed and necrotic liver rubbing up against the peritoneum. The name 'Monash sign' has been suggested for this clinical sign, after the Monash Medical Centre in Melbourne, Australia.[3]
Hydatid fremitus
Hydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst.
Pericardial fremitus
Pericardial fremitus is a vibration felt on the chest wall due to the friction of the surfaces of the pericardium over each other. See pericardial friction rub for the auditory analog of this sign.
Periodontal fremitus
Periodontal fremitus occurs in either of the alveolar bones when an individual sustains trauma from occlusion. It is a result of teeth exhibiting at least slight mobility rubbing against the adjacent walls of their sockets, the volume of which has been expanded ever so slightly by inflammatory responses, bone resorption or both. As a test to determine the severity of periodontal disease, a patient is told to close his or her mouth into maximum intercuspation and is asked to grind his or her teeth ever so slightly. Fingers placed in the labial vestibule against the alveolar bone can detect fremitus.[4]
References
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- ↑ fremitus at Dorland's Medical Dictionary
- ↑ Sohn C, Baudendistel A (1995). "Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report". Ultrasound Obstet Gynecol. 6 (3): 205–7. doi:10.1046/j.1469-0705.1995.06030205.x. PMID 8521071.
- ↑ Nagappan R, Parkin G, Tsui A, Sievert W (2001). "Hepatic fremitus: 'Monash sign'". Intern Med J. 31 (9): 567–8. doi:10.1046/j.1445-5994.2001.00145.x. PMID 11767877.
- ↑ Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 12
