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Consolidation of the Lung
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
This unwell man displays respiratory distress at rest, with a tachypnoea of 26 per minute, fever, a tachycardia of 108 per minute and evidence of central cyanosis. His trachea is central, he has reduced expansion of this chest on the left with an area of increased tactile fremitus affecting the lower half of his left chest posteriorly. Percussion reveals this area to be dull in nature: auscultation demonstrates increased breath sounds, whispering pectoriloquy, increased vocal fremitus with coarse crepitations that alter with coughing. These clinical signs are in keeping with a diagnosis of left lower lobe consolidation. In view of this man's high temperature, the cause is most likely to be infective in nature.
The respiratory system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Altered vocal resonance is best heard over areas of consolidation, and is best described as an increase in clarity of the words heard (with an almost booming nature) through the chest wall. This sign is called bronchophony, and is due to the increased sound-conducting properties of solid tissue over air. If vocal resonance is present, it may be easier to hear as ‘whispering pectoriloquy’. The whispered voice is conducted very clearly, as it consists largely of high-frequency noises – almost like being in a whispering gallery.
Auscultation of Breath Sounds
Published in Noam Gavriely, David W. Cugell, Breath Sounds Methodology, 2019
Voice sounds are readily audible but not easily recognizable when heard on the chest wall with a stethoscope. In health, spoken words are muffled and obscure, with an upper frequency of approximately 250 Hz.106 Those lung diseases that cause a decrease in the amplitude of breath sounds or percussion note (pleural effusion or fibrosis, obstructed bronchus, obesity, solid tumors, etc.) result in a decrease in amplitude and additional muffling of vocal sounds. In a pneumothorax, vocal sounds are diminished although the percussion note is enhanced. Other lung diseases have the opposite effect, so that spoken sounds are loud and more easily recognizable (pneumonia, consolidation, atelectasis with a patent bronchus, etc.). The term bronchophony is used to describe vocal sounds with an abnormal increase in amplitude and in spoken clarity. When whispered voice sounds behave similarly it is known as pectoriloquy. A special form of bronchophony is egophony — a sound resembling the letter “a” when the patient utters the letter “e”. An increase in whispered voice sound is the most sensitive of vocal sound abnormalities, and as a sign of lung consolidation can often be appreciated prior to the appearance of abnormal breath sounds or adventitious sounds. There is increased transmission of higher-frequency sound through consolidated lung — up to approximately 400 Hz.106
Identifying the gap in clinical skills: a pilot study investigating the use of clinical respiratory examination skills in practice
Published in Education for Primary Care, 2021
Sophia Kerzner, Randi Q. Mao, Janhavi Nikhil Patel, Shreyas Sreeraman, Jason Profetto
Auscultating for breath sounds was the only skill in the entire survey to be unanimously useful. (100%). Additionally, almost all respondents (98.7%) felt that auscultating for breath sounds should be taught. The three auscultation techniques for consolidation (aegophony, whispered pectoriloquy, and bronchophony), were rated as useful by less than 20% of respondents. Most respondents felt that the consolidation tests should not be taught to students.