Tubal murmur

Specialty: Respiratory.

• bronchial murmur
• pathological bronchial breathing
• condensation puff

Why it occurs

• Typical bacterial lobar pneumonia (the consolidated and airless lung parenchyma transmits laryngotracheal sounds with great fidelity and amplification through the patent bronchi towards the chest wall)
• Passive or compressive pulmonary atelectasis due to moderate pleural effusion (compression of the underlying lung tissue that acts as a solid medium transmitting tracheal noise, auscultating above the upper limit of the liquid)
• Cavitary pulmonary tuberculosis with patent drainage bronchus (cavernous murmur, high-resonance variant of the tubal murmur)
• Large consolidated pulmonary infarction (with blood alveolar occupation and preservation of bronchial patency)
• Massive coalescent lung metastases forming a consolidation block without occlusion of the main airway

Initial workup

Anteroposterior and lateral digital chest x-ray; Bedside thoracic ultrasound (demonstration of pulmonary hepatization with dynamic air bronchogram); Computed tomography (CT) of the chest with contrast; Blood analysis with leukocyte count, procalcitonin and arterial lactate; Blood cultures and sputum culture.

Standard management

• Antibiotic treatment directed according to the suspected etiology of the pneumonia: Amoxicillin/Clavulanate (875/125 mg orally every 8 hours or 1 g/200 mg intravenously every 6 hours) associated with Clarithromycin (500 mg orally every 12 hours to cover atypical germs).