Crepitations in the Peribronchial Area
Yes, crepitations (crackles) can occur in the peribronchial area and are clinically significant findings associated with various airway and parenchymal diseases.
Mechanism and Clinical Significance
Crepitations in the peribronchial region indicate pathology affecting either the airways themselves or the surrounding lung parenchyma. 1 These discontinuous, explosive sounds are typically heard during inspiration and represent:
- Airway secretions or lesions causing abnormal airflow patterns 1
- Parenchymal disease such as interstitial lung disease affecting peribronchial structures 1
- Peribronchial inflammation or edema involving the connective tissue sheath surrounding bronchi 2
Common Causes of Peribronchial Crepitations
In Children (1-24 months)
- Bronchiolitis is the most common cause, presenting with tachypnea, wheeze, and crackles in infants 1-23 months 3
- Protracted bacterial bronchitis and suppurative lung disease cause persistent crepitations from airway secretions 1
- Aspiration lung disease produces peribronchial inflammation and crackles 1
In Adults
- Broncholithiasis causes crepitations when calcified peribronchial lymph nodes impinge on or erode into airways, often presenting with harsh cough and hemoptysis 1
- Bronchiectasis produces crackles from chronic airway inflammation and secretions, though physical examination findings do not reliably correlate with HRCT findings 1
- Tracheobronchial amyloidosis causes submucosal infiltration leading to cough and abnormal breath sounds 1
- Pulmonary edema produces peribronchial cuffing from edema involving both the bronchial wall and peribronchial interstitial space 4
Diagnostic Approach
When crepitations are detected in the peribronchial area, the clinical context determines the next steps:
- In children 1-23 months with acute onset: Diagnose bronchiolitis clinically without routine chest radiography if tachypnea, wheeze, and crackles are present 3
- In patients with chronic cough and crepitations: Obtain CT scan to evaluate for bronchiectasis, broncholithiasis, or interstitial disease 1
- When calcified structures are visible on imaging: Consider broncholithiasis and proceed with bronchoscopy for definitive diagnosis 1, 5
Important Clinical Pitfalls
Do not rely on auscultatory findings alone for diagnosis. Physical examination findings including crackles are insufficient without objective testing such as spirometry or imaging 3. The presence or absence of crackles on chest auscultation does not correlate reliably with bronchiectasis on HRCT scanning 1.
Peribronchial crepitations differ from simple rhonchi or wheezes. Crackles are discontinuous explosive sounds heard during inspiration, while rhonchi are continuous low-pitched sounds (≤200 Hz) typically heard during expiration 3. This distinction guides differential diagnosis toward parenchymal or small airway disease rather than large airway obstruction.
In broncholithiasis, bronchoscopy may miss the diagnosis. CT identified calcified lymph nodes in all 15 patients in one series, but bronchoscopy visualized broncholiths in only 5 of 10 cases with endobronchial nodes 5. Therefore, CT with thin sections (≤0.5 cm) is essential when broncholithiasis is suspected 5.