Tactile fremitus

Template:Search infobox 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.

• Increased sound throughout the chest

• Diffuse alveolitis
• Diffuse fibrosis
• Lobar pneumonia
• Streptococcus pneumoniae

• Decreased sound throughout the chest

• Asthma
• Atelectasis
• Bronchitis
• Chylothorax

• traumatic disruption of the thoracic duct

• Emphysema
• Foreign body aspiration
• Hemothorax

• chest trauma
• instrumentation

• Pleural effusion

• CHF
• Cancer
• Pulmonary embolus
• Pneumonia
• Connective tissue disease
• Pancreatitis
• Renal disease
• Liver disease

• Pleural thickening
• Ronchal fremitus

• Airway secretions

• Friction fremitus

• pleural friction rubs

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:

• CBC
• pulse oximetry
• electrolytes
• BUN / creatinine
• calcium
• glucose
• Blood culture / sputum culture
• Arterial blood gas
• pulmonary function tests

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