Fine Inspiratory Crackles

MANUAL OF CLINICAL DIAGNOSIS

Fine inspiratory crackles are abnormal lung sounds heard during auscultation when the patient inhales. These sounds, also known as crackles or rales, are high-pitched and often compared to the sound of crumpling cellophane or hair being rubbed near the ear. Fine crackles indicate the presence of fluid in the alveoli or the late opening of small airways and collapsed alveoli. This finding can be associated with various pulmonary pathologies and is crucial for the clinical evaluation and differential diagnosis of respiratory diseases.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Secondary to Normal Secretions	Cough, expectoration, crackles that disappear after coughing	Medical history, physical examination	Resolution after expectoration, no further testing required
Pulmonary Oedema	Dyspnoea, orthopnoea, crackles at lung bases, wheezing, peripheral oedema	Medical history, physical examination, crackles at bases	Chest X-ray, echocardiogram, arterial blood gas analysis
Pulmonary Oedema Secondary to Trauma	Chest pain, dyspnoea, history of trauma, crackles	History of trauma, physical examination	Chest X-ray, chest computed tomography (CT)
Pulmonary Fibrosis	Progressive dyspnoea, dry cough, basal crackles, clubbing	Medical history, physical examination, basal crackles	Chest X-ray, high-resolution CT (HRCT), lung biopsy
Interstitial Lung Disease	Dyspnoea, dry cough, crackles, fatigue	Medical history, physical examination, crackles	Chest X-ray, HRCT, lung biopsy
Chronic Bronchitis	Productive cough, dyspnoea, wheezing, scattered crackles	Smoking history, physical examination	Spirometry, chest X-ray
Emphysema	Dyspnoea, chronic cough, barrel chest, decreased breath sounds, occasional crackles	Smoking history, physical examination	Chest X-ray, chest CT, spirometry
Consolidation Secondary to Infection	Fever, productive cough, chest pain, crackles	Medical history of respiratory infection, physical examination	Chest X-ray, chest CT, sputum culture