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pulmonary crackles; rales
Etiology:
1) Late inspiratory crackles:
a) sudden reinflation of previously deflated airways
b) pneumonia
c) dependent regions of lungs
- congestive heart failure
- acute aortic insufficiency
- diffuse pulmonary fibrosis
- shallow respirations in bedridden & elderly
2) Early inspiratory crackles:
- COPD/bronchitis
- May be heard at mouth
3) Inspiratory & expiratory crackles:
a) bronchiectasis
b) secretions in trachea & large bronchi
- pulmonary edema
- patients who cannot cough up secretions
Pathology:
- rales are produced by movement of thick exudate or the vibration of inflammed or edematous membranes
- the presence of rales indicates that fluid has permeated the terminal bronchioles & alveoli, which can be due either to heart failure or to primary pulmonary disease, especially pneumonia
Clinical manifestations:
- crackling or bubbling sounds heard during auscultation of the lungs
Related
Randomized ALdactone Evaluation Study (RALES)
General
abnormal chest sound
References
- Guide to Physical Examination & History Taking, 4th edition,
Bates B, JB Lippincott, Philadelphia, 1987
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 306