Crackles

Crackles
ICD-10	R 09.8
ICD-9	786.7

Crackles, crepitations, or rales 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 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, or bronchiectasis. Pulmonary edema secondary to left-sided congestive heart failure can also cause rales.

1 Terminology
2 The sound of crackles
3 See also
4 References
5 External links

Terminology

The terms rales and crepitations are both still in common use in the US but less common elsewhere.^[1] Use of the term rales has been discouraged by the American Thoracic Society and American College of Chest Physicians since 1977,^[2] by numerous authors,^[3] and this is enforced by the editorial policy of a number of major medical journals.^[1]

In Sweden, crepitations refer specifically to fine, dry crackles.^[4]

The sound of crackles

Crackles are caused by explosive opening of small airways^[3] and are discontinuous,^[5] 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 don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or acute respiratory distress syndrome.

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.

Coarse crackles are somewhat louder, lower in pitch, and last longer than fine crackles. They have been described as sounding like opening a Velcro fastener. 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.^[6]

Crackles can be heard over the lower lobe of the lungs. Pulmonary edema makes it much more audible.