The manifestation of bundle branch block due to lesions within the his bundle. A dilemma in electrocardiographic interpretations.

CHEST, 73: 3, MARCH, 1978 of the graphic records of different adventitious sounds are easily seen, but specific features characteristic of fine crackles or rhonchi, for example, cannot be readily identified. When adventitious sounds originate from multiple sites and produce a cascade of sounds, conventional recording techniques do not allow graphic representation of individual crackles or wheezes. l’his problem was overcome by Murphy et al.8 They used an expanded time axis (800 to 1,600 mm/sec) in their time-amplitude displays and were then able to identify specific features of different adventitious sounds. The following two results were of singular importance: (1) the similarity in tracings made from recordings of adventitious sounds provided by three separate groups; and (2) the ability of Murphy et a18 to characterize adventitious sounds solely on the basis of their graphic appearance. Quantitative methods and graphic records for measurements of respiratory sounds are all well and good, but wherein is the wisdom of relinquishing the tried and true term, rale? Why replace it with crackle? Like Lewis Caroll’s Alice, we, too, can assign words whatever meaning we wish; but redefining rale in acoustic terms, as Forgacs notes has been done for crackle, will be difficult to achieve, in view of the current widespread use of rale and the equally widespread number of meanings. A new term with a well-defined meaning can be incorporated into our regular nomenclature with only modest difficulty. Consider the alternative of continuing to use the term, rule, with the attendant uncertainty over what particular definition the user had in mind. The word, crackle, will be seen with increasing frequency. It has been recommended for general use by a subcommittee on nomenclature to the membership of the American Thoracic Society.9 Considerably more work is needed to establish satisfactory clinical, pathologic, and physiologic correlations with pulmonary sounds. Phonopneumography has a long road to travel before it achieves the importance that phonocardiography now enjoys, but the techniques and concepts are now at hand.