1. Terminology

2. The sound of crackles

3. See also

4. References

5. External links

Crackles are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are often{{Citation needed|date=December 2016}} heard only with a stethoscope ("on auscultation"). Bilateral crackles refers to the presence of crackles in both lungs.

Basal crackles (not to be confused with the basilar artery of the brain) are crackles apparently originating in or near the base of the lung. Bibasal crackles refer to crackles at the bases of both the left and right lungs. Bilateral basal crackles also refers to the presence of basal crackles in both lungs.

Crackles are caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. The word "rales" derives from the French word râle meaning "rattle".

Crackles can be heard in patients with pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis, ARDS, interstitial lung disease or post thoracotomy or metastasis ablation. Pulmonary edema secondary to left-sided congestive heart failure can also cause rales.

Terminology

The terminology of 'rales' and 'rhonchi' in English remained variable until 1977, when a standardization was established by the American Thoracic Society and American College of Chest Physicians.^[5] As a result of this, the term 'râles' was abandoned, and 'crackles' became its recommended substitute. Therefore, these sounds should be correctly described as 'crackles'.^[5][6] The term 'rales' is still common in English-language medical literature, but cognizance of the ATS/CHEST guidelines calls for 'crackles'.

In 2016, the European Respiratory Society reported on a study wherein various physicians listened to audiovisual recordings of auscultation findings and interobserver variation was analyzed.^[7] The study found that broad descriptions agreed better than detailed descriptions.^[7]

The sound of crackles

Crackles are caused by explosive opening of small airways^[6] and are discontinuous,^[8] nonmusical, and brief. Crackles are much more common during the inspiratory than the expiratory phase of breathing, but they may be heard during the expiratory phase. Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that do not clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure, pulmonary fibrosis, or acute respiratory distress syndrome. Crackles that partially clear or change after coughing may indicate bronchiectasis.

• Crackles are often described as fine, medium, and coarse. They can also be characterized as to their timing: fine crackles are usually late-inspiratory, whereas coarse crackles are early inspiratory.
• Fine crackles are soft, high-pitched, and very brief. This sound can be simulated by rolling a strand of hair between one's fingers near the ears, or by moistening one's thumb and index finger and separating them near the ears. Their presence usually indicates an interstitial process, such as pulmonary fibrosis or congestive heart failure. The sounds from interstitial pulmonary fibrosis have been described as sounding like opening a Velcro fastener.
• Coarse crackles are somewhat louder, lower in pitch, and last longer than fine crackles. Their presence usually indicates an airway disease, such as bronchiectasis.

They can also be described as unilateral or bilateral,^[9] as well as dry or moist/wet.^[10]

See also

• Bronchophony
• Egophony
• Rhonchi
• Consumption
• Whooping cough
• Croup
• Pulmonary edema
• Pertussis toxin
• Allergic asthma
• Respiratory sounds

References

External links

• Audio Breath Sounds - Multiple case studies with audio files of lung sounds.
• R.A.L.E. Repository - sound files of breath sounds

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