From the Research
Decreased tactile fremitus is primarily caused by conditions that obstruct the transmission of vocal vibrations from the lungs to the chest wall, with the most common causes including pleural effusion, pneumothorax, COPD, pleural thickening, and obesity. These conditions create barriers that dampen the vibrations produced when a person speaks. For example, in pleural effusion, the fluid acts as a buffer that absorbs sound vibrations, while in emphysema, the hyperinflated lungs with destroyed alveoli conduct sound poorly 1. Pneumothorax creates an air space that doesn't transmit vibrations effectively. Clinically, decreased tactile fremitus is an important physical examination finding that helps diagnose these underlying conditions.
When assessing tactile fremitus, the examiner places their hands on the patient's chest wall and asks them to repeat words or phrases, feeling for the intensity of vibrations. Areas with decreased fremitus warrant further investigation with imaging studies like chest X-rays or ultrasound to confirm the underlying pathology. According to a recent study, commercially available AI tools can assist in detecting airspace disease, pneumothorax, and pleural effusion on chest radiographs with moderate to high sensitivity 2.
The most common causes of pleural effusion, which is a major cause of decreased tactile fremitus, are congestive heart failure, cancer, pneumonia, and pulmonary embolism 1. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax, and chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax 3.
Key points to consider in the diagnosis and management of decreased tactile fremitus include:
- Pleural effusion and pneumothorax are common causes of decreased tactile fremitus
- COPD, especially emphysema, can also cause decreased tactile fremitus
- Imaging studies like chest X-rays or ultrasound are essential for confirming the underlying pathology
- AI tools can assist in detecting airspace disease, pneumothorax, and pleural effusion on chest radiographs
- Treatment of the underlying condition is crucial in managing decreased tactile fremitus.