What Does "Friable" Mean in Medical Context?
Friable describes tissue that is easily crumbled, torn, or damaged with minimal manipulation or trauma, indicating abnormal tissue fragility that requires careful handling during examination and procedures.
Clinical Definition and Characteristics
Friable tissue exhibits abnormal fragility and lacks normal structural integrity. When tissue is described as friable, it means:
- It bleeds easily upon contact or minimal manipulation 1
- It crumbles or tears with gentle pressure 2
- It demonstrates poor structural cohesion 3
The term is commonly used across multiple medical specialties to describe pathologically weakened tissue that cannot withstand normal mechanical stress.
Common Clinical Contexts
Gastrointestinal/Endoscopic Findings
In ulcerative colitis assessment, friability is considered too subjective and ill-defined by the FDA to be included in formal disease scoring 1. The FDA specifically excludes friability from the modified Mayo endoscopy subscore because it lacks standardized definition and reproducibility 1.
Gynecological Presentations
Friable cervical or uterine masses often indicate:
- Neoplastic processes (such as placental site trophoblastic tumor presenting as a friable cervical mass protruding through the cervical os) 4
- Tissue that bleeds easily during examination or biopsy 4
Cardiovascular Manifestations
Friable coronary arteries represent a critical finding in spontaneous coronary artery dissection (SCAD), particularly in young patients and postpartum women 3. These vessels:
- Are associated with connective tissue disorders and peripartum hormonal changes 3
- Require cautious approach during percutaneous intervention, with only 65% success rates 3
- May propagate dissection if manipulated aggressively 3
Infectious/Surgical Complications
In the context of infection, friable tissue indicates:
- Severe tissue compromise from disseminated infection (such as Mycobacterium chimaera causing mediastinal tissue friability with anastomotic dehiscences) 2
- Persistent infection leading to structural tissue breakdown 2
- Increased surgical risk and complication rates 2
Clinical Implications and Management Considerations
Key Pitfalls to Avoid
- Do not assume friability alone confirms infection—it may indicate neoplasia, inflammation, or vascular pathology 4, 2, 3
- Avoid aggressive manipulation of friable tissue during procedures, as this increases bleeding risk and may propagate underlying pathology 3
- Recognize that friable tissue may require modified surgical techniques with gentler handling and alternative approaches 2, 3
Diagnostic Approach
When encountering friable tissue: