Pleural rubbing

Primary or secondary pleuritis causes roughening of the two pleural leaves.

Due to this roughening, the leaves of the parietal and visceral pleura cause auscultatory phenomena that can be heard throughout the entire respiration.

The breathing excursions are weakened on the affected side, we find a so-called gentle breathing.

Sometimes the arm is pressed close to the thorax on the affected side to keep the breathing excursions as low as possible because of the pain.

Otherwise, the usual symptoms of pleuritis can be found such as:

• superficial and accelerated breathing
• Shortness of breath
• Breath-dependent pain, which may radiate into the back
• occasionally feverish
• Tachypnea

Auscultation

• Auscultation reveals a respiratory synchronous rubbing sound that is present throughout the respiratory cycle. The sound is near the ear and at p.m. in the area of greatest respiratory excursion (i.e., at the end of inspiration and beginning of expiration). Pleural rubbing is heard only in the lower portions of the lungs, where greater movement of the two pleural leaflets is possible. Pleural rubbing in the upper lung segments cannot be auscultated. If pleural effusion develops during the course of the disease, the sound disappears progressively until it is finally no longer auscultable.

Percussion

• inconspicuous; only with the occurrence of an effusion does an attenuation of the percussion sound occur.

Vocal fremitus

• inconspicuous; only after the occurrence of an effusion the sound is attenuated or even abolished

1. Anschütz F (1978) The physical examination 100-101
2. Baum E et al (2011) Degam Guideline No. 15 AWMF Register No. 053/023 S 81, 84
3. Loscalzo J et al (2011) Harrison's Pulmonary Medicine and Intensive Care 3
4. Siegenthaler W et al (2000) Siegenthaler's differential diagnosis 249