Abnormal Breath Sounds
- the absence of sound and/or
- the presence of 'normal' sounds in areas where they are normally not heard.
- For example, bronchial (loud & tubular) breath sounds are abnormal in peripheral areas where only vesicular (soft & rustling) sounds should be heard. When bronchial sounds are heard in areas distant from where they normally occur, the patient may have consolidation (as occurs with pneumonia) or compression of the lung. These conditions cause the lung tissue to be dense. The dense tissue transmits sound from the lung bronchi much more efficiently than through the air-filled alveoli of the normal lung.
- pleural friction rubs
- Crackles are often described as fine, medium, and coarse.
- Fine crackles are soft, high-pitched, and very brief. You can simulate this sound by rolling a strand of hair between your fingers near your ear, or by moistening your thumb and index finger and separating them near your ear.
- Coarse crackles are somewhat louder, lower in pitch, and last longer than fine crackles. They have been described as sounding like opening a Velcro fastener.
Listen to crackles at the University of Loyola's website (courtesy of Dr. David Cugell, Northwestern University and the American College of Chest Physicians.)
Crackles at The R.A.L.E.® Repository, courtesy of Dr. Pasterkamp
- Wheezes that are relatively high pitched and have a shrill or squeaking quality may be referred to as sibilant rhonchi. They are often heard continuously through both inspiration and expiration and have a musical quality. These wheezes occur when airways are narrowed, such as may occur during an acute asthmatic attack.
- Wheezes that are lower-pitched sounds with a snoring or moaning quality may be referred to as sonorous rhonchi. Secretions in large airways, such as occurs with bronchitis, may produce these sounds; they may clear somewhat with coughing.
Listen to wheezes at the University of Loyola's website (courtesy of Dr. David Cugell, Northwestern University and the American College of Chest Physicians.)
Wheezes at The R.A.L.E.® Repository, courtesy of Dr. Pasterkamp
Listen to a pleural rub at the University of Loyola's website (courtesy of Dr. David Cugell, Northwestern University and the American College of Chest Physicians.)
- their loudness,
- timing in the respiratory cycle,
- location on the chest wall,
- persistence of the pattern from breath to breath, and
- whether or not the sounds clear after a cough or a few deep breaths.
- secretions from bronchitis may cause wheezes, (or rhonchi), that clear with coughing
- crackles may be heard when atelectatic alveoli pop open after a few deep breaths
Listen to stridor at the University of Loyola's website (courtesy of Dr. David Cugell, Northwestern University and the American College of Chest Physicians.)
Stridor at The R.A.L.E.® Repository, courtesy of Dr. Pasterkamp
The Lung Auscultation Course from the University of Loyola includes self evaluation case studies. Explore this excellent resource!
The Lung and Thorax Exam demonstration by Jessica Nishikawa
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