It is usually taught that the typical signs of lobar pneumonia are bronchial breathing, bronchophony and increased tactile fremitus, but the onset of a lobar pneumonia is rarely associated with bronchial breath sounds, bronchophony and increased tactile fremitus, the classical signs of a lobar pneumonia as obtained by auscultation. The inspiratory breath sounds are usually vesicular in quality but much reduced in intensity or entirely absent at first. They not only are faint but also sound as if they came from a greater distance than normally. The expiratory breath sound may be fainter than the normal or slightly increased in intensity and duration. At this time not only is there no bronchophony present, but the transmission of the spoken voice may be much reduced and the tactile fremitus may be absent or reduced in intensity over the area of pneumonia. This period of faint and distant vesicular breath sounds may
FAHR G. THE ACOUSTICS OF THE BRONCHIAL BREATH SOUNDS: APPLICATION TO PHENOMENA OF AUSCULTATION AS HEARD IN LOBAR PNEUMONIA. Arch Intern Med (Chic). 1927;39(2):286–302. doi:10.1001/archinte.1927.00130020125010
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