What is tactile fremitus?

• A. Vibration of the chest wall resulting from sound transmitting through lung tissue
• B. A sensation of chest tightness during inspiration
• C. The muffling of breath sounds due to pleural effusion
• D. An abnormal heartbeat murmur during lung exam

Answer: (A)

Tactile fremitus is the palpable vibration felt on the chest wall when a patient speaks. The voice-generated sounds travel through the airways and lung tissue, and if they reach the chest wall, you can feel the vibrations with your hand. The strength of fremitus changes with lung density: it’s usually felt more strongly over areas of consolidation where sound travels well, and it’s diminished when air or fluid interferes with transmission, such as with pleural effusion, pneumothorax, or COPD. In practice, you put a hand on the chest and have the patient say a syllable like “ninety-nine” to compare vibrations on both sides. The other options describe chest tightness, muffled breath sounds, or an abnormal cardiac murmur, which are not tactile fremitus.