“Velcro-type” crackles predict specific radiologic features of fibrotic interstitial lung disease

Abstract

Background“Velcro-type” crackles on chest auscultation are considered a typical acoustic finding of Fibrotic Interstitial Lung Disease (FILD), however whether they may have a role in the early detection of these disorders has been unknown. This study investigated how “Velcro-type” crackles correlate with the presence of distinct patterns of FILD and individual radiologic features of pulmonary fibrosis on High Resolution Computed Tomography (HRCT).MethodsLung sounds were digitally recorded from subjects immediately prior to undergoing clinically indicated chest HRCT. Audio files were independently assessed by two chest physicians and both full volume and single HRCT sections corresponding to the recording sites were extracted. The relationships between audible “Velcro-type” crackles and radiologic HRCT patterns and individual features of pulmonary fibrosis were investigated using multivariate regression models.Results148 subjects were enrolled: bilateral “Velcro-type” crackles predicted the presence of FILD at HRCT (OR 13.46, 95% CI 5.85–30.96, p < 0.001) and most strongly the Usual Interstitial Pneumonia (UIP) pattern (OR 19.8, 95% CI 5.28–74.25, p < 0.001). Extent of isolated reticulation (OR 2.04, 95% CI 1.62–2.57, p < 0.001), honeycombing (OR 1.88, 95% CI 1.24–2.83, < 0.01), ground glass opacities (OR 1.74, 95% CI 1.29–2.32, p < 0.001) and traction bronchiectasis (OR 1.55, 95% CI 1.03–2.32, p < 0.05) were all independently associated with the presence of “Velcro-type” crackles.Conclusions“Velcro-type” crackles predict the presence of FILD and directly correlate with the extent of distinct radiologic features of pulmonary fibrosis. Such evidence provides grounds for further investigation of lung sounds as an early identification tool in FILD.

Diagnostic test interpretation and referral delay in patients with interstitial lung disease

“…While lung crackles can sometimes be auscultated in the dependent lung portions of healthy individuals [20], they should be considered pathologic when failing to resolve over several breath cycles. The presence of pathologic lung crackles are strongly predictive of pulmonary fibrosis [21], and have accordingly been proposed as a screening tool for ILD [22].…”

Digital Lung Auscultation: Will Early Diagnosis of Fibrotic Interstitial Lung Disease Become a Reality?

“…Earlier access to a tertiary care center might be facilitated by improved methods of lung sound detection, including the recognition of so-called "Velcro-like" crackles, a hallmark feature that is present early in the disease course of IPF and in many fibrotic ILDs (10).…”

“…A subjective assessment of Velcro-like crackles bilaterally on chest auscultation predicts the presence of fibrotic ILD and usual interstitial pneumonia patterns on HRCT (10,11), and is associated with varying degrees of different ILAs (10). Hence, Velcro-like crackles may provide a rationale for investigating lung sounds to accurately identify patients with ILD, and could even be used as a screening aid.…”

Estertores tipo velcro

“…Recientemente, 2 estudios reportaron la utilidad de los estertores tipo velcro en la evaluación del paciente con enfermedad pulmonar intersticial (6,7). En el primero de ellos, Sellarés y colaboradores analizaron los datos de 132 pacientes incluidos de forma prospectiva en un programa de enfermedad pulmonar intersticial de una institución de referencia en España; los sujetos se dividieron en 2 grupos de acuerdo con la presencia (63 %) o no (37 %) de estertores tipo velcro.…”

“…Por su parte, Sgalla y colaboradores investigaron la posible correlación de los estertores tipo velcro con la existencia de distintos patrones radiológicos de enfermedades pulmonares intersticiales fibróticas (7). Para ello, grabaron digitalmente la auscultación pulmonar de 148 pacientes previo a la realización de la TACAR.…”