Abnormal Breath Sounds


Abnormal breath sounds include:

The term “adventitious” breath sounds refers to extra or additional sounds that are heard over normal breath sounds. Sources differ as to the classification and nomenclature of these sounds, but most examiners commonly use the following terms to describe adventitious breath sounds.

Detection of adventitious sounds is an important part of the respiratory examination, often leading to diagnosis of cardiac and pulmonary conditions.

Crackles (or rales) are caused by fluid in the small airways or atelectasis. Crackles are referred to as discontinuous sounds; they are intermittent, nonmusical and brief. Crackles may be heard on inspiration or expiration. The popping sounds produced are created when air is forced through respiratory passages that are narrowed by fluid, mucus, or pus. Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome (ARDS).


Listen to crackles at the University of Loyola's website (courtesy of Dr. David Cugell, Northwestern University and the American College of Chest Physicians.)

More crackles at The R.A.L.E. Repository, courtesy of Dr. Pasterkamp


Wheezes are sounds that are heard continuously during inspiration or expiration, or during both inspiration and expiration. They are caused by air moving through airways narrowed by constriction or swelling of airway or partial airway obstruction.


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


Pleural friction rubs are low-pitched, grating, or creaking sounds that occur when inflamed pleural surfaces rub together during respiration. More often heard on inspiration than expiration, the pleural friction rub is easy to confuse with a pericardial friction rub. To determine whether the sound is a pleural friction rub or a pericardial friction rub, ask the patient to hold his breath briefly. If the rubbing sound continues, its a pericardial friction rub because the inflamed pericardial layers continue rubbing together with each heart beat - a pleural rub stops when breathing stops.


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.)


Stridor refers to a high-pitched harsh sound heard during inspiration.. Stridor is caused by obstruction of the upper airway, is a sign of respiratory distress and thus requires immediate attention.

If adventitious sounds are heard, it is important to assess:


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


Instant Feedback:

Rhonchi are discontinuous popping sounds heard during inspiration.
True
False


The Auscultation of the Lungs course from the University of Loyola includes self evaluation case studies. Explore this excellent resource!

For example, click here, and then click on Case 3.  Listen to the lung field sounds, and then answer the following question:


Instant Feedback:

The adventitious sound heard in the upper apices of the lungs in this case are best described as:
Rhonchi
Wheezes
Crackles
Stridor

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