Fremitus
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Fremitus is a palpable vibration on the human body. In common medical usage, it usually refers to (tactile) vocal fremitus, although there are several other types.
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[edit] Bronchial Fremitus
See rhonchal fremitus below.
[edit] Hepatic Fremitus
Hepatic fremitus is a vibration felt over the patient's liver. It is thought to be caused by a severely inflamed and necrotic liver rubbing up against the peritoneum. The name 'Monash sign' has been suggested for this clinical sign, after the Monash Medical Centre in Melbourne, Australia (Nagappan et al, 2001).
[edit] Hydatid Fremitus
Hydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst.
[edit] Pectoral Fremitus
See vocal fremitus below.
[edit] Pericardial Fremitus
Pericardial fremitus is a vibration felt on the chest wall due to the friction of the surfaces of the pericardium over each other. See pericardial friction rub for the auditory analog of this sign.
[edit] Pleural Fremitus
Pleural fremitus is a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs. See pleural friction rub for the auditory analog of this sign.
[edit] Rhonchal Fremitus
Rhonchal fremitus, also known as bronchial fremitus, is a palpable vibration produced during breathing caused by partial airway obstruction. The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. See rhonchus (rhonchi) for the auditory analog of this sign.
[edit] Subjective Fremitus
Subjective fremitus is a vibration felt by the patient on humming with the mouth closed.
[edit] Tactile Fremitus
See vocal fremitus below.
[edit] Tussive Fremitus
Tussive fremitus is a vibration felt on the chest when the patient coughs.
[edit] Vocal Fremitus
Vocal Fremitus, also called pectoral fremitus, or tactile vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat the phrase 'ninety-nine' while the examiner attemps to detect vibrations on the chest wall.
Vocal fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial bifurcation. Vocal fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (collapsed lung).
It has recently been suggested that the artifacts caused by eliciting vocal fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors (Sohn and Baudendistel, 1995).
[edit] References
- Nagappan R, Parkin G, Tsui A, Sievert W (2001). "Hepatic fremitus: 'Monash sign'". Intern Med J 31 (9): 567-8. PMID 11767877.
- Sohn C, Baudendistel A (1995). "Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report". Ultrasound Obstet Gynecol 6 (3): 205-7. PMID 8521071.
- (2005) Venes D Taber's Cyclopedic Medical Dictionary, 20th Edition, Philadelphia, PA: F. A. Davis Company. ISBN 0803612087
- (2003) Dorland WAM Dorland's Illustrated Medical Dictionary, 30th Edition, Philadelphia, PA: W.B. Saunders Company. ISBN 0721601464
