Fremitus 3972599 223172528 2008-07-02T21:56:45Z 203.122.250.64 <!-- NOTE: Please do not add info on '''Fremitus''' Christian Outreach. It does not belong here. Put that in a separate article. --> '''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. ==Bronchial fremitus== See ''rhonchal fremitus'' below. ==Hepatic fremitus== '''Hepatic fremitus''' is a vibration felt over the patient's liver. 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 (Nagappan et al, 2001). ==Hydatid fremitus== '''Hydatid fremitus''' is a vibratory sensation felt on palpating a [[hydatid cyst]]. ==Pectoral fremitus== See ''vocal fremitus'' below. ==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 rub]] for the auditory analog of this sign. ==Periodontal fremitus== '''Periodontal fremitus''' occurs in either of the [[alveolar bone]]s when an individual sustains [[occlusal trauma|trauma from occlusion]]. 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.<ref>Trauma from Occlusion Handout, Dr. Michael Deasy, Department of Periodontics, NJDS 2007. page 12</ref> ==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 rub]] 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== See ''vocal fremitus'' below. ==Tussive fremitus== '''Tussive fremitus''' is a vibration felt on the chest when the patient coughs. ==Vocal fremitus== '''Vocal Fremitus''', also called pectoral fremitus, or tactile vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat the phrase 'boy oh boy' (or any other [[diphthong]] such as 'toy boat' and 'blue balloons') while the examiner attempts to detect vibrations on the chest wall. The phrase 'ninety-nine' is also commonly used. The German language equivalent ''neun und neunzig'', is a diphthong, and is appropriate. Vocal 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. Vocal 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 travel quicker through liquid (the consolidation) than air. Conversely, the reason for decreased fremitus in a pleural effusion (or any pathology separating the pleura), is that this increased space between the pleura acts as a barrier to the sound waves. It has recently been suggested that the artifacts caused by eliciting vocal fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors (Sohn and Baudendistel, 1995). ''' ==References== {{reflist}} * {{cite journal | author=Nagappan R, Parkin G, Tsui A, Sievert W | title=Hepatic fremitus: 'Monash sign' | journal=Intern Med J | year=2001 | pages=567–8 | volume=31 | issue=9 | pmid=11767877 | doi=10.1046/j.1445-5994.2001.00145.x}} * {{cite journal | author=Sohn C, Baudendistel A | title=Differential diagnosis of mammary tumors with vocal fremitus in sonography: preliminary report | journal=Ultrasound Obstet Gynecol | year=1995 | pages=205–7 | volume=6 | issue=3 | pmid=8521071 | doi=10.1046/j.1469-0705.1995.06030205.x}} * {{cite book | author = | authorlink = | coauthors = | year = 2005 | month = | title = Taber's Cyclopedic Medical Dictionary | chapter = | editor = Venes D | others = | edition = 20th Edition | pages = | publisher = F. A. Davis Company | location = Philadelphia, PA | id = | url = }} ISBN 0-8036-1208-7 * {{cite book | author = | authorlink = | coauthors = | year = 2003 | month = | title = [[Dorland's Illustrated Medical Dictionary]] | chapter = | editor = Dorland WAM | others = | edition = 30th Edition | pages = | publisher = W.B. Saunders Company | location = Philadelphia, PA | id = | url = }} ISBN 0-7216-0146-4 <!-- NOTE: Please do not add info on Fremitus Christian Outreach. It does not belong here. Put that in a separate article. --> [[Category:Medical terms]] [[Category:Medical signs]] [[de:Stimmfremitus]]