Correlation between lung sounds and HRCT signs of pulmonary fibrosis: a blinded prospective study

Sgalla, Giacomo, Walsh, Simon, Sverzellati, Nicola, Fletcher, Sophie, Cerri, Stefania, El-Gohari, Magdy, Dimitrov, Borislav, Nikolic, Dragana, Barney, Anna, Luppi, Fabrizio, Jones, Mark, Davies, Donna, Richeldi, Luca and Hansell, David (2017) Correlation between lung sounds and HRCT signs of pulmonary fibrosis: a blinded prospective study. European Respiratory Journal, 50. (doi:10.1183/1393003.congress-2017.PA865).

Abstract

The assessment of “velcro” crackles at chest auscultation is a key component in the diagnostic pathway of fibrotic interstitial lung disease (ILD). However, the presence of “velcro” crackles has not been prospectively evaluated for association with findings at chest high resolution computed tomography (HRCT).

We recruited three prospective cohorts of patients (n=273) undergoing chest HRCT for any clinical indication. Lung sounds were recorded from each patient before HRCT using an electronic stethoscope over different sites on the posterior chest. Acoustic files were then blindly and independently assessed by two respiratory physicians for the presence of “velcro” crackles. Eight hundred and five HRCT images corresponding to the anatomical sites of sound recording were blindly and independently reviewed by two expert thoracic radiologists for the presence and extent of radiologic findings indicative of pulmonary fibrosis.

The relationships between the semi-quantitative scores of radiologic abnormalities at HRCT and the presence of “velcro” crackles as assessed by the two chest physicians were assessed using multiple logistic regression. The extent of honeycombing (OR 1.66; 95% CI 1.08-2.53; p=0.02), reticulation (OR 1.72; 95% CI 1.3-2.27; p=0.00) and ground glass opacities (OR 1.66; 95% CI 1.23-2.23; p=0.01) were independently associated with the presence of “velcro” crackles.

The findings of this prospective study show that “velcro” crackles correlate with the presence and the extent of different radiologic patterns of fibrosis at HRCT. These results support the inclusion of acoustic findings in the management of patients with ILD.

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Contributors

Author: Dragana Nikolic

Author: Anna Barney

Author: Mark Jones

Author: Donna Davies

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