Overview
This lecture explains how to assess tactile fremitus and how its findings differ in normal lungs, pneumonia (consolidation), pleural effusions, and pneumothorax.
Tactile Fremitus Basics
- Tactile fremitus is a vibration felt on the chest or back during low-frequency vocalization (e.g., saying "99").
- Vibrations are felt using the bony part of the hand placed symmetrically on the patient’s thoracic cavity.
Tactile Fremitus in Different Conditions
Normal Lung
- In a normal lung, vibrations travel through airways and lung tissue to the chest wall and are normally felt as baseline fremitus.
Pneumonia (Consolidation)
- Pneumonia causes consolidation, which is pus or fluid within the lung tissue.
- Tactile fremitus is increased over areas of consolidation.
- Vibration amplifies through liquid/pus because sound travels better through fluid than air.
Pleural Effusion
- Pleural effusion is fluid between the visceral and parietal pleura, outside the lung tissue.
- Tactile fremitus is decreased or absent below the level of fluid in pleural effusion.
- The fluid acts as a buffer, blocking vibration transmission since it is not connected to the bronchus.
Pneumothorax
- Pneumothorax is air between the visceral and parietal pleura (outside the lung).
- Tactile fremitus is markedly decreased or absent over a pneumothorax.
- The air in the pleural space blocks or blunts vibration transmission more than fluid does.
Key Terms & Definitions
- Tactile Fremitus — Vibration felt by hand on the chest/back during a patient’s vocalization.
- Consolidation — Area of lung tissue filled with fluid or pus, commonly due to pneumonia.
- Pleural Effusion — Collection of fluid between the lung’s two pleural linings.
- Pneumothorax — Presence of air between the visceral and parietal pleura.
Action Items / Next Steps
- Practice palpating tactile fremitus on peers to distinguish normal, increased, and decreased fremitus.
- Review assigned reading on lung physical examination maneuvers.