I only heard it once before on a patient at work and showing my nurse she didn't hear it. So today at clinical my patient had the same sound. It was an expiratory sound. Deep tone, almost slow rumble. Kind of like a growl. Patient was awake. So not snoring and I did not hear it without auscultation.

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Is it a pleural friction rub?

That's exactly what it sounded like! I only heard it in the upper lobes though. Both times I've heard it I only heard it there. I think it makes sense that I wouldn't hear it today as there is a lung mass in the lower right lobe of today's patient, but not sure why I wouldn't have heard it on my work patient.

So what is this sound telling me then? Is this related to her CHF? That's a different sound normally.

a pleural friction rub is the abrasive/scraping sound of the pleura's two layers sliding against each other. It usually seen in pleurisy.

Pleurisy - PubMed Health

And yet, of all her multiple diagnoses, pleuracy is not one of them. Weird.

Were you listening over bare skin?

I have had students describe hearing similar sounds in the past and it has almost always been friction rubs of clothing not the pleura.

Yes. Always on bare skin. I ran EMS for a while so although there was the rare case I didn't do on bare skin, I'm pretty familiar with the fabric rubbing sound. However, hospital gowns are so easy to move out of the way, there really is no excuse not to place the stethoscope on the skin.

It would be fairly unusual to hear a loud pleural rub under normal (non-forced) expiration, as they tend to be more prominent during inspiration. With CHF and large pleural effusions you could hear a rub but likely not at the apex.

I would consider rhonchi vs coorifice crackles/rales as more likely options.

I thought maybe ronchi because of the expiratory but that I'm familiar with and this didn't sound like it.

Great site: Learn Lung Sounds

Audio Reference guide:

http://www.easyauscultation.com/lung-sounds-reference-guide.aspx

Thanks for the help guys. It's not required to know anything but that it's "abnormal" this semester, however, next I think is when they up the anty and require us to know the specific sounds, so I'm trying to get a jump on things when I see or hear something I don't know.

Rhonchi can have a low rumbling sound. A nice open airway with some mucus can cause that. It probably was heard in the upper lobes because it was mainly located in the bronchus on exhalation. Just my thoughts :)

Great site: Learn Lung Sounds

Audio Reference guide:

Auscultating The Lungs - Reference Guide

This is an awesome site! Thank you sooooo much