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Crackles are the clicking, rattling, or
crackling noise Crackling noise arises when a system is subject to an external force and it responds via events that appear very similar at many different scales. In a classical system there are usually two states, on and off. However, sometimes a state can exis ...
s that may be made by one or both
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s of a human with a respiratory disease during
inhalation Inhalation (or Inspiration) happens when air or other gases enter the lungs. Inhalation of air Inhalation of air, as part of the cycle of breathing, is a vital process for all human life. The process is autonomic (though there are exceptions ...
. They are usually heard only with a
stethoscope The stethoscope is a medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, and one or two tubes connected to two earpieces. ...
("on
auscultation Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hea ...
"). Pulmonary crackles are abnormal breath sounds that were formerly referred to as rales. Bilateral crackles refers to the presence of crackles in both lungs. Basal crackles 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 Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit. Uses in anatomy and zoology * Pulmonary alveolus, an air sac in the lungs ** Alveolar cell or pneumocyte ** Alveolar duct ** Alveolar macrophage * ...
collapsed by fluid, exudate, or lack of aeration during expiration. Crackles can be heard in patients with pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis,
bronchiectasis Bronchiectasis is a disease in which there is permanent enlargement of parts of the bronchi, airways of the lung. Symptoms typically include a chronic cough with sputum, mucus production. Other symptoms include shortness of breath, hemoptysis, co ...
,
acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
(ARDS), interstitial lung disease or post thoracotomy or metastasis ablation. Pulmonary edema secondary to left-sided congestive heart failure can also cause crackles.


Terminology

René Laennec adopted the existing word '' râles'' (which has been translated as "rattles", 'groans" and otherwise) to describe the added breath sounds that are now referred to as "crackles". He described them using unusual daily examples, such as "whistling of little birds", "crackling of salt on a heated dish", "cooing of the woodpidgeon", etc., but he soon realized that he was unable to use the term in front of his patients because it conjured the association of ''le râle de la mort'', which translates to " the death rattle", the noise that people who are about to die make when they can no longer clear secretions. Therefore, at the bedside, he used the Latin word ''
rhonchus Respiratory sounds, also known as lung sounds or breath sounds, refer to the specific sounds generated by the movement of air through the respiratory system. These may be easily audible or identified through auscultation of the respiratory system ...
'', which originally meant a '
snore Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of ob ...
'. That was not clearly understood by his translator, John Forbes, and the terminology became very confusing after the publication in the 1830s of Forbes's English translation of Laennec's ''De L'Auscultation Mediate''. The difficulty of translating ''râle'' itself had been remarked upon in a British review of Laennec's work in 1820. 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 The American College of Chest Physicians (CHEST) is a medical association in the United States consisting of physicians and non-physician specialists in the field of chest medicine, which includes pulmonology, critical care medicine, and sleep med ...
. As a result, the term ''râles'' was abandoned, and "crackles" became its recommended substitute. 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 of various physicians listening to audiovisual recordings of auscultation findings and interobserver variation was analyzed. The study found that broad descriptions agreed better than detailed descriptions.


Sound

Crackles are caused by explosive opening of small airways and are discontinuous, 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 Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
, pulmonary fibrosis, or
acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
. Crackles that partially clear or change after coughing may indicate
bronchiectasis Bronchiectasis is a disease in which there is permanent enlargement of parts of the bronchi, airways of the lung. Symptoms typically include a chronic cough with sputum, mucus production. Other symptoms include shortness of breath, hemoptysis, co ...
. * 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, as well as dry or moist/wet.


See also

* Bronchophony * Egophony * Consumption * Whooping cough *
Croup Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms o ...
* Pertussis toxin * Allergic asthma * Respiratory sounds


References


External links


Audio Breath Sounds
- Multiple case studies with audio files of lung sounds.

- sound files of breath sounds {{Circulatory and respiratory system symptoms and signs Symptoms and signs: Respiratory system