Rattling noise

Classification according to ICD-10
R09.8	Other specified symptoms affecting the circulatory and respiratory systems
R09.8	Rattling noises
ICD-10 online (WHO version 2019)

Rattling noises (abbreviation RGs , English crackles, rales ) are perceptible noise phenomena during auscultation (eavesdropping) of the lungs , which arise from the movement of liquids or secretions in the airways during inspiration and expiration . They are among the breathing noises that superimpose normal breathing sounds and indicate pathological changes in the lungs. The term "rattle noise" is considered to be out of date according to more recent guidelines, but in everyday clinical practice it is still often used as a synonym for discontinuous breathing noises.

Classification

Discontinuous breathing sounds

Discontinuous background noises (formerly damp or non-musical background noises / rattling noises) are generated by thin secretions ( e.g. edema fluid ) - especially during inhalation (inspiration). They can be divided into three classes:

coarse-bubble (also: big bubbly, English. English coarse crackles )
medium-bubble
kleinblasig (also: feinblasig, engl. english fine crackles )

The nature of the noise indicates which section of the airway is affected. Coarse-bubble rattling noises occur in sections with a larger lumen , fine- bubble rattling noises in small-lumen sections. Coarse rattling noises are found especially in pulmonary edema or bronchiectasis . Occasionally they are so clear that they can be heard without a stethoscope . Mid-bubble RG occur, for example, in the context of bronchitis . Rattling noises with fine bubbles are typical of a problem in the vicinity of the alveoli , for example in the context of pneumonia .

The sound aspect of moist rattling noises depends on the tissue layers between the stethoscope and the diseased tissue area. A distinction is therefore made between three further sound properties:

sounding
non-sounding
metallic

Ringing rattling noises have a higher pitch and speak for a diagnosis that is “close to the ear”. In the case of non-sounding rattling noises, the finding is more "distant from the ear", that is, inside the lungs, near the bronchi . A metallic sound of rattling noises is recorded in pneumothorax .

Continuous noises from breathing

Continuous background noises (formerly dry, bronchitic or musical background noises / rattling noises) are stridor , humming, purring, whistling and wheezing. Constrictions of the airways due to viscous secretions, usually in connection with swelling of the mucous membrane , trigger an accelerated flow that generates audible vibrations of the air column in the airways and sound more melodic than discontinuous background noises.

Stridor is a flow noise that is audible through the windpipe when you inhale or exhale and that can be carried out through the mouth. A stridor occurs when the upper airways are narrowed.
Humming ( rhonchi ) is a low-frequency noise that is caused by irregular, changing coatings and floating mucus threads in the large airways. If you blow between two closely held sheets of paper, a humming sound is created, which stops when the breath ceases.
Whistling / wheezing (English wheeze ). Whistling is a high-frequency sound that occurs due to severe constriction of the airways from mucus or contraction of airways. Whistling occurs in everyday life when a gas is emptied with a squeaky sound from a reservoir with a narrow outlet. Wheezing is the orchestral sounding of breathing air, which escapes into the large airways, obstructed by narrowed smallest airways (bronchioles). Whistling and wheezing are often used synonymously . This breathing sound is typical of chronic obstructive pulmonary disease (COPD) and bronchial asthma .

Individual evidence

^ Respiratory Sounds. In: Am. J. Respir. Crit. Care Med. Volume 156, Number 3, September 1997, pp. 974-987
^ Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition, ibid. 1986, ISBN 3-13-352410-0 , pp. 81–85 ( rattle noises ), here: pp. 82 f.

literature

SURFmed Update 2010, Guidelines Medicine of Switzerland, Philippe Furger

This text is based in whole or in part on the entry rattle noise in Flexikon , a wiki of the DocCheck company . The takeover took place on November 16, 2007 under the then valid GNU license for free documentation .

[1] Respiratory Sounds. In: Am. J. Respir. Crit. Care Med. Volume 156, Number 3, September 1997, pp. 974-987

[2] Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition, ibid. 1986, ISBN 3-13-352410-0 , pp. 81–85 ( rattle noises ), here: pp. 82 f.