Crunching and rubbing – am I hearing this appropriately?

Some non-pulmonary sounds could also be heard on auscultation of the chest. It is very important to concentrate on non-pulmonary sounds equivalent to mediastinal crackles and pleural rubs.

• is attributable to pneumomediastinum. This sound is characterised by precordial crackles that correlate with the heartbeat fairly than respiration. To appreciate this difference, you could ask the patient to temporarily hold their breath.
• results from the mutual sliding of inflamed and rough pleural surfaces in the course of the movement of the chest wall. This sound is non-musical and is described as “grinding”, “creaking”, or “the sound made when walking on fresh snow”. Inflammation or cancer may cause the surface of the pleura to thicken, which then causes more friction as they slide over one another, creating this sound. Any potential reason behind pleural effusion, pleurisy, or serositis may end in pleural friction (i.e., inflammation, malignancy). Patients may have the option to explain the situation of the abrasion based on the pain. Pleural friction is a symptom of pleural disease, although its absence doesn’t exclude this pathology.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13^vol ed.). Wolters Kluwer Health: Philadelphia.