Pleural versus Pericardial Friction Rub: |
Pleural |
Pericardial |
Auscultatory sounds: |
One sound on inspiration and one sound on expiration
(expiratory sound may be absent)
|
One systolic sound and two diastolic sounds
(systolic sound between S1 and S2)
(one diastolic sound in early diastole and one at end diastole)
(sounds are independent of respiration) |
(pleural) |
(pericardial) |
Site: |
Over lower anterolateral chest (left or right) |
Over pericardium, often loudest at LLSB |
Sound superficial; close to chest wall |
Sound farther from chest wall |
Rub often transient |
Rub often transient
Note: many patients with a pericardial friction rub also have a tachycardia
|
Respiratory variation: |
Sounds disappear if hold breath |
Tends to be louder during inspiration, also can sometimes better detect during forced expiration with the patient leaning forward |
Sound characteristics (similar for both): |
High frequency
(hear best with diaphragm of stethoscope) |
High frequency
(hear best with diaphragm of stethoscope) |
Grating or creaking sound |
Scratchy, gratin or squeaking |