Doppler vocal fremitus

A young woman with metastatic breast cancer was found to have a regular spectral Doppler event spanning multiple cardiac cycles and timing to her tachypneic respiratory rate, which suggested an extracardiac source. A chest CT confirmed a large mediastinal mass causing a postobstructive pneumonia. This Doppler signal reflected increased turbulence across the obstructed bronchus due to sound wave conduction through a pulmonary consolidation—a Doppler equivalent of “vocal fremitus” elicited by physical examination of a patient with a lung mass or pneumonia. Careful attention to the timing of Doppler abnormalities is required to avoid misdiagnosis.