Image of the Week: What audible finding is consistent with this presentation?

A 40-year-old man presents to the emergency department with sharp chest pain and palpitations. He says the pain is worse when he lies down and is exacerbated by coughing, but it improves when he moves to a seated position. He was recently diagnosed with systemic lupus erythematosus after investigation for recurrent cyanotic discoloration and numbness of his fingers following exposure ...