Chroches in the lungs

Rhinchi (rhonchi) - respiratory noise caused by narrowing of the respiratory tract or the presence of pathological contents in them. Chypes occur mainly in the bronchi, less often - in the cavities that have a bronchial message (cavity, abscess).

Since the onset of wheezing is due to the rapid movement of air, they are better listened to at the beginning of the inspiration and into the exhalation koin. The mechanism of wheezing consists of two components.

1. The presence of bronchi in the lumen of more or less dense masses, driven by an air stream.
2. Changes in the state of the wall of the bronchi, and consequently, their lumen, for example, narrowing of the bronchial) lumen, which can be a consequence of the inflammatory process and spasm. This circumstance can explain the frequent occurrence of wheezing in bronchitis, bronchial obstructive syndrome and bronchial asthma.

Rene Laennec described the phenomenon he called rattles: "In the absence of a more specific term, I used this word, denoting all the noises produced during breathing by the passage of air through all the liquids that may be present in the bronchi or lung tissue." These noises also accompany a cough when it is, but it is always more convenient to examine them with breathing. "

Regardless of the type, rales are formed during inspiration and expiration and change when coughing. Distinguish the following varieties of wheezing.

• Dry rales in the lungs: low, high.
• Wet wheezing in the lungs: small-bubbly (ringing and invertebrates), medium-bubbly, large-bubbly.

[1]

Dry rales in the lungs

Dry wheezing occurs when air passes through the bronchi, in the lumen of which there is enough dense contents (thick viscous sputum), and also through bronchi with a narrowed lumen due to swelling of the mucous membrane, spasm of smooth muscle cells of the bronchial wall or tumor tissue growth. Chryps can be tall and low, wearing a whistling and buzzing character. They are always audible throughout the inhalation and exhalation. The height of wheezing can be judged on the level and degree of narrowing of the bronchi. A higher timbre of sound (rhonchi sibilantes) is characteristic for obstruction of small bronchi, a lower (rhonchi sonori) is noted in the lesions of bronchuses of medium and large calibers. At the same time, the difference in the rhythm of wheezing when bronchial tubes of different caliber is involved is explained by the different degree of resistance of the air stream passing through them.

The presence of dry wheezing usually reflects a generalized process in the bronchi (bronchitis, bronchial asthma), so they are usually listened to by both lungs. The definition of one-sided dry wheezes over a certain area, especially in the upper segments, usually indicates the presence of a cavity in the lung (most often a cavity).

[2], [3]

Wet wheezing in the lungs

With accumulation in the bronchi of less dense masses (liquid sputum, blood, edematous fluid), when the air stream passing through them produces a characteristic buoyant effect, traditionally compared with the sound of bursting vesicles, when air is blown through a tubule dropped into a vessel with water, damp rales are formed.

The character of wet wheezing depends on the caliber of the bronchi, where they arise. There are small-bubble, medium-bubbly and large-bubbling rales that arise respectively in the bronchi of small, medium and large calibers. When involved in the process of bronchial tubes of different calibres, various rales are revealed.

The most frequent wet wheezing is observed in chronic bronchitis, as well as in the stage of resolving an attack of bronchial asthma; while small-bubbly and medium-bubbling rales are inadvertent, since their sonority decreases when passing through a heterogeneous environment.

Important is the detection of sonorous wet wheezing, especially small bubbles, the presence of which always indicates that there is a peribronchial inflammatory process, and the best conduct of sounds arising in the bronchi on the periphery is due in this case to the compaction (infiltration) of the lung tissue. This is especially important for the detection of infiltration sites in the apex of the lungs (for example, in tuberculosis) and in the lower parts of the lungs (for example, foci of pneumonia against the background of blood stagnation due to heart failure).

Calling medium-bubble and large-bubbling rales reveal less often. Their appearance testifies to the presence in the lungs of partially filled with fluid cavities (cavity, abscess) or large bronchiectasises, communicating with the respiratory tract. Asymmetric their localization in the region of apices or lower lobes is characteristic precisely for the indicated pathological conditions, whereas symmetrical rales testify to the stagnation of blood in the lung vessels and the entry of the liquid part of the blood into the alveoli.

With pulmonary edema, moist, large bubbling rales are audible at a distance.

Crepitus

Among the many auscultative symptoms, it is very important to distinguish between crepitus - a kind of sound phenomenon, similar to crunching or crackling, observed during auscultation.

Crepitation occurs in the alveoli, most often if they have a small amount of inflammatory exudate. At the height of the inspiration, there is a splitting of many alveoli, the sound of which is perceived as crepitus; it resembles a slight crackle, which is usually compared with the sound produced by rubbing the hair between the fingers near the ear. Listen crepitations only at the height of inspiration and regardless of the cough thrust.

• Creption is primarily an important sign of the initial and final stage of pneumonia (crepitatio indux and crepitatio redux), when the alveoli are partially free, air can enter them and at the height of the inspiration cause their separation. In the midst of pneumonia, when the alveoli are completely filled with fibrinous exudates (the stage of curation), crepitation, like vesicular breathing, is naturally not listened.
• Sometimes crepitation is difficult to distinguish from finely bubbly sonorous wheezing, which, as mentioned above, has a completely different mechanism. In order to distinguish these sound phenomena, indicative of various pathological processes in the lungs, it should be borne in mind that wheezing is audible during inspiration and exhalation, and crepitation only at the height of inspiration; after a cough rales can temporarily disappear. It should be avoided, unfortunately, the use of the still misleading term "crepitating wheeze", which mixes the phenomena of crepitation and wheezing, which are quite different in origin and place of origin.

The sound alveolar phenomenon, very reminiscent of crepitation, can also occur with deep inspiration and with some changes in the alveoli not of the classic pneumonic nature. It is observed in the so-called fibrosing alveolitis. In this case, the sound phenomenon persists for a long time (for several weeks, months and years) and is accompanied by other signs of diffuse lung fibrosis (restrictive respiratory failure).

[4], [5], [6], [7]