Pleural rub

98 Pleural rub



Instruction


This patient presented with sudden onset of lateral chest pain aggravated by deep inspiration and coughing.


Listen to this patient’s chest.


Examine her chest.



Salient features



History




• Sharp localized pain worse on coughing or deep respiration


• Nature of the sputum (purulent expectoration in a patient with chest infection, haemoptysis in pulmonary embolism)


• Drug history (oral contraceptives).



Examination




• Pleural rub (superficial, scratchy, grating sound heard on deep inspiration).


Proceed as follows:



• Differentiate between pleural rub and crackles by asking the patient to cough and check whether or not there is any change in the nature (no change with the pleural rub).


• Tell the examiner that you would like to proceed by listening for tachycardia and right ventricular gallop (pulmonary embolism).



Diagnosis


This patient has a pleural rub (lesion), which is caused by either underlying infection or pulmonary embolism (aetiology). You would like to analyse blood gases to determine whether she is hypoxic (functional status).


Be prepared to discuss prophylaxis of pulmonary embolism.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Pleural rub

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