About a year ago my dr. heard a sound in my back when I would take deep breaths. He didn't know what it was so he ordered a chest x-ray and a chest cat scan. Everything came back normal. He was baffled so sent me to a pulmonary specialist. The specialist said I have a pleural friction rub and that there is nothing wrong with my lungs. He did say that he's a little baffled by the fact that the rub hasn't gone away. Since seeing the specialist I've seen two other dr.'s, one was my OB/GYN for my annual check-up and the other was a new dr. I had to see for a get acquainted visit because we changed insurances and had to change dr's. I didn't tell either of those Dr's about the pleural friction rub. They both heard it when listening to my back. And both of them said they didn't think it was a rub. They both said it sounded like something vascular because they hear a noise and then a pause and then a noise again. So now I'm worried all over again. I was pretty much reassured by the specialist that it was a rub and now I've had two other Dr's tell me it doesn't sound like that to them. Granted the specialist is considered the 'expert' when it comes to the lungs but when two other dr's tell you something different you start to wonder. Does anyone know if pleural friction rubs can sound like mine? Thanks!

Rubs are so hard to diagnose. Really.

It would only be something vascular if it was timed with your heart and not your breathing. If you took a breath and the rub sounds exactly the same from breath-to-breath (this is usually how you can distinguish a rub from crackles) then it's probably a rub.

You might have another kind of rub, like a pericardial rub. I don't even know if these exist, but I imagine they could. It probably isn't anything serious.

The pulmonary specialist said it's not a pericardal (sp) rub and explained why of which I don't remember the explanation. So what the heck is it? I'm starting to think I'm some kind of 'freak' walking around with this sound in my back. I've 'talked' to you about this before wrin. I'm glad you answered my post. I thought I was satisfied with the specialists explanation until I have someone listen to it and they disagree with him. Didn't you tell me once before that sometimes a rub won't go away and will always be heard? The specialist did say that because I am so thin it is easier to hear on me. Why doesn't the rub cause pain?

The rub might not cause pain because it isn't rubbing on a part of your pleura that's hideously packed with pain receptors. A good thing to know is that your visceral pleura (the stuff wrapping your lungs) has no pain receptors, whereas your parietal pleura (or the stuff that lines your ribcage,) does. So if your parietal pleura isn't getting rubbed on, or the rub isn't very big, it probably won't cause pain.

Yes, a rub might stay for-ever-and-ever. Some things might even CAUSE a rub. I have a friend who had a rather nasty pleural effusion after surgery for a burst appendix, and had to have a chest tube inserted. She now has a very distinct pleural friction rub over her right lower lobe, posteriorly. It's just scarring that's happened on the pleura that's touching. It doesn't cause her any pain, but it sounds MOST interesting with a stethoscope. Sounds like crackles, but you can tell they're not because it makes the exact same pattern of creaking no matter how she inhales, and exhales. Creak-creakcreak, creak. Creak. Creakcreak.

The thinner you are the less bone and fat and tissue that can distort the sound. Kind of like listening to someone speak through a thin wall as opposed to a thick wall. Ne?

Maybe the rub didn't match to your heart rate, like a pericardial rub would? I don't know. But like I said before -- rubs are deceptive -- they can sound like a lot of things.

Thanks again wrin. I wish you could stick your stethescope (sp) through the computer and take a listen! LOL So are you saying, by your creak, creak, description of a rub that a rub can make a sound, pause and then make a sound, like mine does. That's why so many dr's have said its a blood flow or vascular 'thing.' Here's a list of docs that don't think it's a rub, my OB/GYN, my internist and our family dr. Here's who thinks it is a rub, a pulmonary specialist. Who would you go with? LOL No one ever heard it until I had a nasty respitory virus in December of 2001. Could that cause a rub?

It might have made a little bit of inflammation in your pleura -- but if all tests have come back normal, shrug.

Sometimes they just come and go as they please!

I'd go with your pulmonary specialist. GPs and internists and ob/gyns don't hear pleural rubs nearly as often as pulmonologists do -- not that having other testing done would hurt. Well, ... just your wallet.

What other kind of testing would there be? I had the chest x-ray and the CT scan with contrast and then 6 months later another chest x-ray. Everything was normal.

I just heard on the news today of the reporter who died over in Iraq from a pulmonary embolism. Of course I had to look it up and in one part it mentioned that a small embolism could cause a rub. YIKES!!! Now I'm worried about that. Can you calm my fears on this one? I think I'll just be the happiest person when one day I go to the Doc and he doesn't hear the darn thing! Maybe I need to put on some poundage so no one will hear it! LOL

I just hate being someone that 'stumps' the docs. Knock on wood, I've always been SOOOOOOO healthy, never a hospital stay other than childbirth, no broken bones, no stitches, no illnesses, NOTHING! I guess it's just hard for me to 'swallow' the fact that I can't get a definitive answer on this one! Thanks for tryin' to help!

BTW, have you heard of the country singing group called Emerson Drive? They are from Alberta, I think around Grande Prairie.

Testing to make sure it isn't a vascular thing -- like an echocardiogram, or an ECG, a V/Q scan, or the more invasive cardiac catheterization, pulmonary angiogram, etc. (Though I doubt they'd do those unless they were REALLY freaked.)

A small embolism could cause a rub by causing tissue death which would easily harbor infection and therefore inflammation which would cause a rub. Etc.

Chances are very good that you're okay. If your doctors don't think you've got a PE (especially considering that you've never had any other kind of clotting problems like MI, CVA, DVT,** etc) then they aren't going to be worried about it. Wouldn't hurt to ask though. I'm not sure how much a V/Q scan would cost ...

I can imagine that sucks. Really. I'm fairly certain you're okay, though. If you've been checked out by a pulmonologist and have had a CT and CT says you're fine, you're probably fine.

(no, I haven't. But I will keep an eye out. http://www.healthboards.com/ubb/wink.gif)

I did have an echo dopplar as well. Forgot to add that to my list. That was when my internist thought it was vascular and before he sent me to the pulmonary specialist. Actually after my internist did the chest x-ray, chest catscan with contrast and the echo and all were normal he was willing to drop the whole issue and just say that I had a 'funny sound' and be done with it. I couldn't handle the not knowing so that's when he sent me on to the specialist and he's the one that took one listen and said, 'it's a pleural friction rub.'

Thank you for your help! I do appreciate your efforts in trying to not only educate me but reassure me.

So, if this is indeed a rub caused by a virus is it true that it could have scarred and will never go away? Have you heard of that before? My internist said it should relubricate and go away. But as we all know, 'that' *ain't* happenin? eh? LOL

Be on the lookout for Emerson Drive. They're a great band and starting to get lots of recognition here in the U.S.

It might go away, it might not. Depends on how bad the infection was.

My friends' rub is from scarring that's extensive enough to be seen on a chest x-ray. It will probably never go away.

Yours might! You never know.

Wrin, guess what? I called my pulmonary specialist back again. It was just freaking me out too much that two other Docs heard the 'sound' and thought it might be something other than a rub. My pulmonary specialist said it had been over a year since my CT scan so he wanted me to have another one just to make sure nothing had changed. He set it up so I could have the scan and then come directly to his office for the results. I had it done today. And once again everything came back normal. He said, like you said, that it may NEVER go away. He understands why I get 'freaked' when other Docs listen and get concerned. He said 'rubs' aren't that common and that 'other' Docs don't hear them that often. The only place you can hear the 'rub' is on the lower left side of my back. He said that confirms even more that it is a pleurisy related rub, most likely from a virus, because that is where pleurisy settles, lower in the lungs. He did say that he could follow me and repeat the CT scan in a year. I agreed to it. What do you think? He really is a wonderful Doc and is doing his best to reassure me. I told him that maybe I need to add a few pounds so other Docs won't hear it. We had a laugh out of that!

I think your dr. is right on with it -- if it isn't causing you any pain or trouble then may as well leave it alone -- if it's already sat for a year and not done anything like get bigger or start hurting then I don't see any reason to continue firing at it with the anti-inflammatories or worry about it at all.

Your pulm. specialist knows what he's doing http://www.healthboards.com/ubb/smile.gif I'm glad he's not trying to medicate you to death. Next time a doctor comments on it, just mention that a pulmonologist diagnosed you with a pleural friction rub in that area a year and change ago -- they'll listen harder to make sure the sound isn't something else, and probably just leave it alone.

LOL that is very funny but you are right about that -- rubs are much easier to hear in thinner people, but thinner people are easier to listen to on general principle -- as long as they're not so thin that their ribs are sticking out and I can't get a seal with my stethoscope LOL

Wrin, but why the heck does he want to follow me and do another scan in a year? I was hoping to walk out of there and never return! LOL Just the fact that he wants to follow me still leaves me with that shadow of a doubt! Grrrrrrrrrrrrrr!!!

Just because having a constant rub there might create some inflammation or other kinds of things -- having a rub makes you a little more prone to getting a pleurisy again, that kind of thing.

It's just to keep an eye on it and make sure it doesn't turn into something -- I'm willing to bet after 3-4 normal scans that he'll let you go every 2 years or something. You might want to phone him and ask!

Wrin, I forgot to tell you this. Did you know that a symptom of rheumatoid arthritis or lupus could be a pleural friction rub? He did blood work to test for those as well and they all came back normal. But sometimes those things don't show up on a blood test in the early stages. My mom has a very mild case of rheumatoid arthritis. So he said we could be in the early stages of that. But for now I don't show any signs of it either.

You say, 'other things,' could develop from a rub. Please tell me those 'other things' aren't anything to worry about! LOL

those 'other things' aren't anything to worry about LOL

And I say that not just to placate you, but because it is very true. If you don't start noticing symptoms, something will happen on the CT. If you start noticing symptoms, especially of rheumatoid arthritis, you'll notice.

These conditions aren't like, cancer -- they won't sit silently and get worse and worse and worse without symptom until the point where they'll kill you. You'll notice. Your pulmonologist isn't worried, I'm not worried, I know you're going to want to worry, but it's best to forget about it.

This said, if you do notice a sharp pain in the area of your rub that happens predominantly on inspiration or with a cough, phone your pulmonologist and make an appointment. But unless you notice a symptom, don't worry about it.

Thanks! I appreciate your replies and knowledge. Sounds like you and my Doc are on the same page with this! LOL What do you think of his comment that the location of the rub, lower left back, even indicates further to him that it's pleurisy because pleurisy tends to settle in the lower part of the lungs. Make sense to you?

Another interesting thing he did when I saw him this time is he asked me if I could 'feel' the rub. I looked at him kind of puzzled, not knowing what he meant. He then put his hand over the lower part of my back where he hears the rub and had me take deep breaths. He'd never done that before. He couldn't 'feel' it. What's the all about?

Originally posted by ljs3:
Thanks! I appreciate your replies and knowledge. Sounds like you and my Doc are on the same page with this! LOL What do you think of his comment that the location of the rub, lower left back, even indicates further to him that it's pleurisy because pleurisy tends to settle in the lower part of the lungs. Make sense to you?


Yup. Gravity. Makes sense, right? Pleurisy tends to be pretty localized whereas pleuritis tends to spread out all over your pleura. Bacteria have greater mass than pleural fluid, therefore they'd sink towards the bottom.

The bit about trying to feel the rub -- stethoscopes are very, very sensitive. Sometimes they hear things very quietly and sometimes they hear things very loudly. Some of these things you can feel with your hands -- like sometimes I get a really hoarse wheeze high up in my airways, I don't need a stethoscope to hear it and if I put my hand on my chest wall I can feel the rattle.

If your pleura is rubbing in a HUGE way, like, a lot of your pleura rubbing on a lot of pleura, or on a lot of scarring, then it might create vibrations that are able to transmit through the chest wall and be felt. If he couldn't feel it, this tells me that the rub isn't very large, just noisy! http://www.healthboards.com/ubb/biggrin.gif

wrin, I found this message board doing a search on pleural friction rubs. I'm not sure if that's what I may have, but my curiosity was piqued when you gave advice to see the pulmonologist if the "rub" area became painful.

Here's my situation. I'm a healthy 32 year old, and I'm an RN in surgery. I run alot & am training for an ultramarathon. Yesterday I went for a hilly 20 mile run. I have a bit of exercise induced/exacerbated asthma, so I took puffs off my albuterol inhaler before & after the run. Last night I woke several times short of breath and with sharp left-sided "chest" pain (I'd say around my 5th intercostal space, extending mid-clavicular to mid-axillary). The sharp pain has continued today intermittantly. It is sharper on inspiration, but it also seems to come on unassociated with respirations. I got out my little stethescope & have listened but don't hear anything abnormal (but I do find it difficult to do lung sounds on oneself). I have considered going in to get it checked in the ER but thought I'd do a little internet research first. Complicating matters, I am leaving for a hiking/biking trip to Utah tomorrow morning. Think I should go in or just see what happens in a few days?

Hmm.

I wonder if you have a friend who's good at auscultating and would be able to have a listen? I'm not sure you'd need to go to the emergency room for this -- is there a walk-in clinic you could go to? The GPs there are usually young guys and aren't too bad at what they do.

The place you're describing and the way you describe the pain certainly sounds like pleural pain -- unless you've got some kind of pulled muscle there, which you would probably notice. That's what's tough, is differentiating between pleural pain and musculoskeletal pain.

I think having someone have a listen to see if they can hear anything would be a good idea, but I'm willing to bet it's a muscle pain, mostly because pleural pain is usually described as stabbing and makes breathing difficult, and also because you have the pain come on unassociated with breathing.

I'm not sure what exactly to tell you -- by all means if you feel it warrants an ER visit (I can't feel the pain therefore I don't know how intense it really is) then don't let me dissuade you, but I'm willing to bet that you'd be better treated at a walk-in clinic anyway.

If you do want to have a listen, yes, it is difficult to do lung sounds on oneself, but the sound is very easily confused with fine crackles and sounds a little bit like creaking leather. The cracking sound is differentiated because it usually follows a consistent pattern, and it is much easier to hear on deep breathing (which makes things difficult on people with pleuritic pain, because you tell them to take a deep breath and, wow, if looks could kill,) and in thinner people.

Thanks. I listened & really don't hear anything like creaking leather or crackles. My lung sounds are equal on both sides. You're probably right - musculoskeletal pain. What's concered me is that the pain is very sharp and feels really deep, not more superficial which is how I would expect pulled intercostals to feel, plus it gets sharper the deeper I inspire. It also made me wonder if pleural pain sometimes happens after intense exercise, particularly if a person has a little asthma/lung irritation to begin with. I didn't see it listed as a potential cause in any of the literature I've read. Anyway, if it continues I'll swing by a walk-in clinic. Much appreciation.

Wrin, I just read your reply to the other poster which sparked a question. Is it correct that you can only hear a rub when the person is breathing? And is it correct that a rub can be heard better when one takes deep breaths. The reason I ask is because my Doc heard mine before I started taking deep breaths.

Um, more or less -- if there's no air movement and no chest movement and no pleural movement, nothing should be rubbing.

It's EASIER to hear if someone takes deep breaths, and if your doctor was listening to your lungs I highly doubt you weren't taking deep breaths -- but it's possible to hear them when you're not breathing deep.