Fremitus
Encyclopedia
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.
for the auditory analog of this sign.
phrases), as well as 'blue balloons'. 'Ninety-nine' is classically included, however, this is a misinterpretation of the original German report, in which "Neun-und-neunzig" was the low-frequency diphthong of choice. The direct English translation "Ninety-nine" is occasioned by a high-frequency vibration, not useful for the tactile fremitus test.
Tactile 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. Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion
or pneumothorax
(where there is liquid or air instead of usual lung).
The reason for increased fremitus in a consolidated lung is the fact that the sound waves are transmitted with less decay in a solid or fluid medium (the consolidation) than in a gaseous medium (aerated lung). Conversely, the reason for decreased fremitus in a pleural effusion or pneumothorax (or any pathology separating the lung tissue itself from the body wall) is that this increased space diminishes or prevents entirely sound transmission.
It has recently been suggested that the artifacts caused by eliciting tactile fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors.
. 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.
for the auditory analog of this sign.
. It is a result of teeth exhibiting at least slight mobility rubbing against the adjacent walls of their sockets, the volume of which has been expanded ever so slightly by inflammatory responses, bone resorption or both. As a test to determine the severity of periodontal disease
, a patient is told to close his or her mouth into maximum intercuspation
and is asked to grind his or her teeth ever so slightly. Fingers placed in the labial vestibule against the alveolar bone can detect fremitus.
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 rubPleural friction rub
A pleural friction rub, or simply pleural rub, is a medical sign, audible by listening to the internal sounds of the body, usually using a stethoscope on the lungs, that is used in the diagnosis of pleurisy and other conditions affecting the chest cavity....
for the auditory analog of this sign.
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.Subjective fremitus
Subjective fremitus is a vibration felt by the patient on humming with the mouth closed.Tactile fremitus
Tactile Fremitus, known by many other names including pectoral fremitus, tactile vocal fremitus, or just vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat a phrase while the examiner feels for vibrations by placing a hand over the patient's chest or back. Phrases commonly used in English include, 'boy oh boy' and 'toy boat' (diphthongDiphthong
A diphthong , also known as a gliding vowel, refers to two adjacent vowel sounds occurring within the same syllable. Technically, a diphthong is a vowel with two different targets: That is, the tongue moves during the pronunciation of the vowel...
phrases), as well as 'blue balloons'. 'Ninety-nine' is classically included, however, this is a misinterpretation of the original German report, in which "Neun-und-neunzig" was the low-frequency diphthong of choice. The direct English translation "Ninety-nine" is occasioned by a high-frequency vibration, not useful for the tactile fremitus test.
Tactile 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. Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...
or pneumothorax
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
(where there is liquid or air instead of usual lung).
The reason for increased fremitus in a consolidated lung is the fact that the sound waves are transmitted with less decay in a solid or fluid medium (the consolidation) than in a gaseous medium (aerated lung). Conversely, the reason for decreased fremitus in a pleural effusion or pneumothorax (or any pathology separating the lung tissue itself from the body wall) is that this increased space diminishes or prevents entirely sound transmission.
It has recently been suggested that the artifacts caused by eliciting tactile fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors.
Tussive fremitus
Tussive fremitus is a vibration felt on the chest when the patient coughs.Hepatic fremitus
Hepatic fremitus is a vibration felt over the patient's liverLiver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
. 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.
Hydatid fremitus
Hydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst.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 rubPericardial friction rub
A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic. It resembles the sound of squeaky...
for the auditory analog of this sign.
Periodontal fremitus
Periodontal fremitus occurs in either of the alveolar bones when an individual sustains trauma from occlusionOcclusal trauma
Occlusal trauma is a dental term that refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment.When the maxillary and mandibular dental arches approach each together, as they do, for example, during chewing or at rest, the relationship between the opposing...
. It is a result of teeth exhibiting at least slight mobility rubbing against the adjacent walls of their sockets, the volume of which has been expanded ever so slightly by inflammatory responses, bone resorption or both. As a test to determine the severity of periodontal disease
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
, a patient is told to close his or her mouth into maximum intercuspation
Maximum intercuspation
In dentistry, maximum intercuspation refers to the occlusal position of the mandible in which the cusps of the teeth of both arches fully interpose themselves with the cusps of the teeth of the opposing arch...
and is asked to grind his or her teeth ever so slightly. Fingers placed in the labial vestibule against the alveolar bone can detect fremitus.