Fremitus

Fremitus

Fremitus refers to a palpable vibration or tremor that can be felt through the chest wall, often during speech or breathing. It is an important clinical sign that can provide valuable information about the underlying condition of the lungs and pleura.

Types of Fremitus

Fremitus can be classified into several types based on the method of detection and the underlying cause:

Tactile Fremitus

Tactile fremitus is the vibration felt on the chest wall when a patient speaks. It is typically assessed by placing the palms or the ulnar edge of the hands on the patient's chest while they repeat a phrase such as "ninety-nine" or "blue balloons." Increased tactile fremitus may indicate lung consolidation, as seen in pneumonia, while decreased fremitus may suggest pleural effusion or pneumothorax.

Vocal Fremitus

Vocal fremitus is similar to tactile fremitus but is specifically related to the vibrations of the vocal cords transmitted through the lung tissue to the chest wall. It is assessed in the same manner as tactile fremitus.

Pleural Fremitus

Pleural fremitus is a vibration felt on the chest wall due to friction between the pleural layers. It is often associated with pleuritis or pleural effusion.

Rhonchal Fremitus

Rhonchal fremitus is a vibration felt when air passes through mucus or secretions in the bronchial tubes. It is often associated with conditions like bronchitis.

Clinical Significance

The presence and quality of fremitus can provide important diagnostic clues:

• Increased Fremitus: This may indicate lung consolidation, such as in pneumonia, where the lung tissue becomes solidified due to infection and inflammation.
• Decreased Fremitus: This may suggest the presence of air or fluid in the pleural space, such as in pneumothorax or pleural effusion, which dampens the transmission of vibrations.

Assessment Technique

To assess fremitus, the examiner should:

1. Ask the patient to sit upright and breathe normally. 2. Place the hands on symmetrical areas of the chest wall. 3. Ask the patient to repeat a phrase like "ninety-nine" while palpating the chest. 4. Compare the intensity of vibrations on both sides of the chest.

Also see

• Percussion (medicine)
• Auscultation
• Pleural effusion
• Pneumothorax
• Pneumonia