The twisting sound is a very fine and uniform chest auscultation sound, which is heard at the end of inspiration. The sound is similar to the sound produced by twisting a strand of hair with a finger next to the ear, so it is called twisting. It is generally believed that the twisting sound is a small rupture sound produced by the airflow when the alveoli, which are unexpanded or slightly increased in fluid and bonded to each other, are ruptured during inspiration. It can occur in early tuberculosis, early pneumonia, pulmonary bruising, and fibrosing alveolitis. What is the differential diagnosis of twisted sounds? 1. Bacillary cellulitis: The infection is confined to the subcutaneous cellular tissue and spreads rapidly along the fascial spaces, but does not invade the muscles. The onset is usually slow, with an incubation period of 3 to 5 days. Although it also starts with wound pain and twisted pronunciation around the wound, the local pain and systemic symptoms are mild, the skin is rarely discolored, and the edema is also mild. 2, anaerobic streptococcal cellulitis: The onset is slower, and symptoms often appear only 3 days after the injury. Toxemia, pain, local swelling and skin changes are mild. There is emphysema and twisted pronunciation present, but the emphysema is confined to the subcutaneous tissue and fascia. There were general inflammatory manifestations around the wound. The exudate is plasmopurulent and smear examination has streptococci. 3. E. coli cellulitis: intertissue emphysema may occur, and there are toxic symptoms such as hyperthermia and delirium. However, the local swelling develops slowly and the pus has the pus characteristics of E. coli infection, i.e., the pus is thin and plasmacy. Gram-staining negative bacilli can be found on pus smear examination.