Tactile fremitus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

Tactile fremitus is a method of detecting air, fluid or solid material. It can also detect a bronchial obstruction or solid material in the pleural space.

Differential Diagnosis

In alphabetical order. [1] [2]

  • Increased sound throughout the chest
  • Decreased sound throughout the chest
  • traumatic disruption of the thoracic duct
  • chest trauma
  • instrumentation
  • Pleural thickening
  • Ronchal fremitus
  • Airway secretions
  • Friction fremitus

Diagnosis

History and Symptoms

  • Note: Symmetry of chest movement and sound.

Lungs

  • Place hands firmly on patients chest
  • Have them repeat "99" several times
  • The purpose is to feel the vibration of the conducted sound

Laboratory Findings

  • Labs include:

Chest X Ray

  • Aids in exposing pneumonothorax, pneumonia, effusion, atelectasis

MRI and CT

  • consider in the event of an abnormal X-ray

Treatment

  • Attend to airway/breathing patterns
  • Administer supplemental Oxygen
  • Chest tube insertion for pneumothorax, hemothorax, chylothorax

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X




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