From the Research
A rub auscultated during inspiration is a significant finding that typically indicates pleural inflammation, which can result from various conditions including pneumonia, pulmonary embolism, viral infections, or autoimmune disorders like lupus. This finding is most significant as a diagnostic marker for pleurisy or pleuritis. The inspiratory timing is important because it helps differentiate a pleural rub from other sounds like pericardial rubs (which occur with cardiac motion) or crackles (which have different acoustic qualities) 1. Pleural rubs sound like creaking leather or grating and are best heard at the lower lateral chest walls where respiratory movement is greatest.
When you detect an inspiratory rub, further investigation with chest imaging and laboratory tests is warranted to determine the underlying cause. According to a recent study, chest computed tomography (CT) scans are the most accurate type of scans for diagnosing pneumonia, with sensitivity values higher than 95% 2. However, CT scans should only be used in more severe interventions due to cost and radiation exposure. Lung ultrasound is a sensitive and specific method for subsequent lung examination, particularly in pediatric and acute care populations, and is useful in environments that need fast bedside assessment 2.
Treatment should target the primary condition rather than the rub itself, which will resolve as the pleural inflammation improves. Patients with pleural rubs often experience sharp, localized chest pain that worsens with deep breathing, so pain management may be necessary while addressing the underlying condition. It is essential to understand the underlying pathophysiology of various lung sounds generation for better understanding of disease processes 1.
Some key points to consider when evaluating a patient with a pleural rub include:
- The importance of differentiating pleural rubs from other sounds like pericardial rubs or crackles
- The need for further investigation with chest imaging and laboratory tests to determine the underlying cause
- The use of chest CT scans in more severe interventions, and lung ultrasound in pediatric and acute care populations
- The importance of pain management in patients with pleural rubs
- The need to target treatment at the primary condition rather than the rub itself.