WordNet

having the surface decorated with a network of fine cracks, as in crackleware; "a crackle glaze"
to become, or to cause to become, covered with a network of small cracks; "The blazing sun crackled the desert sand"
glazed china with a network of fine cracks on the surface (同)crackleware, crackle china
the sharp sound of snapping noises (同)crackling, crepitation

PrepTutorEJDIC

パチパチと音をたてる / 《the ~》パチパチいう音 / 〈U〉(陶磁器の表面の)細かいひび模様;ひび焼き

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/25 00:59:08」(JST)

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	Crackles Crackles heard in the lungs of a person with pneumonia using a stethoscope.
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Crackles, crepitations, or rales (ⁱ/ˈraːls/ RAHLS or /ˈræls/ RALS) 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 heard only with a stethoscope ("on auscultation"). Bilateral crackles refers to the presence of crackles in both lungs.

Basal or basilar 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 or bibasilar 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, interstitial lung disease or post thoracotomy or metastasis ablation. Pulmonary edema secondary to left-sided congestive heart failure can also cause rales.

Terminology

René Laennec developed the term 'râles' ('rattles' in French) to describe the added breath sounds which 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 soon realised that he was unable to use this term in front of his patients because it conjured the association of 'le râle de la mort', which translates to 'death rattle' i.e. 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 equivalent, 'rhonchus'. This was not clearly understood by his translator, John Forbes, and the terminology became very confusing after the publication of De L'Auscultation Mediate. Therefore in 1977, a standardization was established by the American Thoracic Society and American College of Chest Physicians.^[1] As a result of this, the term 'râles' was abandoned, and 'crackles' became its official substitute. Therefore these sounds should be correctly described as crackles.^[1]^[2]

The sound of crackles

Crackles are caused by explosive opening of small airways^[2] and are discontinuous,^[3] 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, as well as dry or moist/wet.^[4]

References

^ ^a ^b "Report of the ATS-ACCP Ad Hoc Subcommittee on pulmonary nomenclature". ATS News 3: 5–6. 1977.
^ ^a ^b Forgacs P (1978). "The functional basis of pulmonary sounds" (PDF). Chest 73 (3): 399–405. doi:10.1378/chest.73.3.399. PMID 630938.
^ "rale" at Dorland's Medical Dictionary
^ Wrongdiagnosis.com > Crackles Book Source Details: * Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series * Author(s): Springhouse * Year of Publication: 2007

External links

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

UpToDate Contents

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1. 間質性肺疾患を有する成人に対するアプローチ：臨床的評価 approach to the adult with interstitial lung disease clinical evaluation
2. 救急外来における呼吸困難の成人の評価 evaluation of the adult with dyspnea in the emergency department
3. 小児における身体的診察：胸部および腹部 the pediatric physical examination chest and abdomen
4. 小児における無気肺 atelectasis in children
5. 小児における市中肺炎：臨床的特徴および診断 community acquired pneumonia in children clinical features and diagnosis

English Journal

Acoustic estimation of neck fluid volume.

Yadollahi A1, Rudzicz F, Mahallati S, Coimbra M, Bradley TD.
Annals of biomedical engineering.Ann Biomed Eng.2014 Oct;42(10):2132-42. doi: 10.1007/s10439-014-1083-8. Epub 2014 Aug 8.
Recently we showed that fluid accumulation in the neck can narrow the upper airway (UA) and increase its collapsibility, which may exacerbate obstructive sleep apnea (OSA). However, the available methods for measuring neck fluid volume (NFV) are inconvenient and expensive. Narrowing of the UA due to
PMID 25103604

Maternal sounds elicit lower heart rate in preterm newborns in the first month of life.

Rand K1, Lahav A2.
Early human development.Early Hum Dev.2014 Oct;90(10):679-83. doi: 10.1016/j.earlhumdev.2014.07.016. Epub 2014 Sep 9.
BACKGROUND: The preferential response to mother's voice in the fetus and term newborn is well documented. However, the response of preterm neonates is not well understood and more difficult to interpret due to the intensive clinical care and range of medical complications.AIM: This study examined th
PMID 25194837

Physiological Acoustic Sensing Based on Accelerometers: A Survey for Mobile Healthcare.

Hu Y1, Kim EG, Cao G, Liu S, Xu Y.
Annals of biomedical engineering.Ann Biomed Eng.2014 Sep 19. [Epub ahead of print]
This paper reviews the applications of accelerometers on the detection of physiological acoustic signals such as heart sounds, respiratory sounds, and gastrointestinal sounds. These acoustic signals contain a rich reservoir of vital physiological and pathological information. Accelerometer-based sys
PMID 25234130

Japanese Journal

限局性気管支拡張症を呈した35年の経過をもつ気道異物の1例

久保和義,長友安弘,宮内俊一,楠元規生,上野史朗,松本紫朗,綾部貴典,富田雅樹,清水哲哉,岡山昭彦
気管支学 : 日本気管支研究会雑誌 34(3), 242-245, 2012-05-25
背景.気道異物は気管支拡張症の発症原因のひとつとして挙げられるが, 5歳時に誤嚥した気道異物が35年間という長期間介在し,気管支拡張症を引き起こした症例を経験したので報告する.症例. 40歳女性. 2000年頃から咳嗽,喀痰,微熱を繰り返し,気管支拡張症と診断されていた.症状の増悪がみられ, 2008年5月当科入院となった.右前胸部にcrackleを聴取し,胸部CTで右上葉に限局した気管支拡張像を …
NAID 110009457538

Early detection of interstitial pneumonia by monitoring KL-6 in a chronic hepatitis C patient undergoing pegylated interferon and ribavirin therapy

Ichikawa-Yamada Yuki,Joshita Satoru,Tsukahara Yoshinori,Kimura Takefumi,Morita Susumu,Kamijo Atsushi,Umemura Takeji,Ichijo Tetsuya,Matsumoto Akihiro,Yoshizawa Kaname,Tanaka Eiji
HEPATOLOGY RESEARCH 41(9), 904-909, 2011-09
… On examination, remarkable fine crackles were detected by dorsal auscultation and bilateral ground-glass opacities and reticular shadows were depicted by computed tomography. …
NAID 120005248147

心膜液を伴う強皮症腎クリーゼの1例

本田謙次郎,大瀬貴元,須藤裕嗣 [他],上田浩平,鮎澤信宏,正路久美,藤乗嗣泰,関常司,藤田敏郎
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 44(5), 455-461, 2011-05-28
症例は62歳，女性．生来健康だったが3年前から両手指ソーセージ様腫脹，指尖潰瘍とRaynaud症状が出現，口周囲皺の減少もみられ，1年前から労作時呼吸困難も出現した．近医で漢方薬を処方されたが症状に改善はみられなかった．起座呼吸を主訴に前医に入院，乳頭浮腫を伴う高血圧，大量心膜液，うっ血性心不全，肺線維症，破砕赤血球像と腎機能障害を認めた．入院後は降圧治療を行い血圧は150/80 mmHg程度まで …
NAID 10029406882

Related Pictures

★リンクテーブル★

リンク元	「100Cases 71」
関連記事	「crackle」

「100Cases 71」

Crackles
Specialty	Pulmonology
ICD-10	R09.8
ICD-9	786.7

　　[★]

■症例

72歳　女性

現病歴：胸部の感染症にドキシサイクリンをGPに処方された。関節リウマチに長期間罹患しており、9年間、1日7mgのプレドニゾロンを服用している。関節痛のため時々パラセタモールを服用。GPが測定した血圧は138/82mmHgであった。抗菌薬を服用し始める2日前からはじまって5日間熱っぽく、食欲不振であり、ベットから動けないでいる。水は十分に飲ませている。5日目に傾眠傾向となり、起こすことが困難になったため、救急車で救急部に連れてきた。

主訴：傾眠

生活歴：単身。退職した娘が世話をするために引っ越してきている。

家族歴：なし。

身体所見 examination

　小柄である(50kgと評価された)が、最近になって体重が減少したということはない。体温38.8℃。眠たそうであり、命令には応じる。簡単な質問にしか答えない。全身性に筋緊張低下。局所神経症状無し。脈拍：118/min。血圧：104/68mmHg。頚静脈圧上昇せず。足首に腫脹無し。肺底部にcrackles(ラ音)とwheezes(笛音)を認める。関節にわずかに活動性の炎症と変形が認められる。これは関節リウマチの既往と合う所見である。

検査　 investigation

　ヘモグロビン：軽度低下。MCV：正常。白血球増多。ナトリウム低下。カリウム正常。尿素上昇。クレアチニン上昇。

問題0. □と○に入る言葉を述べよ

　1) 傾眠とは□□障害に含まれる

　2) 傾眠とは、刺激を与えなければ□□が低下するが、刺激を与えれば○○する状態である。

問題1. 患者に関連する以下の事項のうち何が傾眠と関係あるのだろうか？2つ選べ。

　1) ドキシサイクリンの副作用

　2) 関節リウマチの重症化

　3) プレドニゾロンの服用歴

　4) パラセタモールの服用歴

　5) 胸部感染症

問題2. 異常な検査所見をどう説明しますか？口頭で述べてください。ぶっちゃけ、やや低血圧であることと、ナトリウム低値が着目点です。腎機能低下は二次的なものです。