Terms Associated with Respiratory Auscultation

• Crackles — Discontinuous/intermittent and brief sounds with a nonmusical quality. Associated with either a pulmonary abnormality such as pneumonia, fibrosis, or early congestive heart failure, or an airway abnormality such as bronchitis or brochiectasis
  Crackles that are cleared by cough are most likely caused by secretions associated with bronchitis or atelectasis.
  • Fine crackles: [] A soft and high pitched, discontinuous, and brief (10 msec) sound. Fine late inspiratory crackles that persist after cough or movement, suggest pulmonary abnormality.
  • Coarse crackles: [] A loud and low pitched, discontinuous, and brief (30 msec) sound.
• Bronchial — Breath sounds that are unequal in length, with expiratory sounds lasting longer than inspiratory sounds. The two are usually separated with a brief period of silence; this gap is most often associated with bronchial breath sounds. If audible, it is best heard over the manubrium (of sternum). When bronchial sounds are heard in more distant locations, suspect fluid-filled or solid lung tissue.
  Expiratory sounds have a loud intensity and high pitch.
• Bronchovesicular — Breath sounds that are equal in length (on inspiration and expiration), and are  sometime spaced by a silent interval. Best heard over the 1st and 2nd anterior intercostals. When bronchovesicular sounds are heard in more distant locations, suspect fluid-filled or solid lung tissue.
  The pitch may vary during expiration.
• Egophony — When the patient is asked to say "ee," the voices are heard as "ay." Normally, you would hear a muffled E sound. This is an E-to-A change, with a nasal quality implies and airlessness in the lungs.  
• Forced Expiratory Time — Using the diaphragm of the stethoscope, listen over the trachea and time the audible expiration. Following a deep breath, ask the patient to exhale as quickly as possible. A forced expiration time of 6 or more seconds suggests obstructive pulmonary disease.
  Three consistent readings with a rest in between are most accurate. Use this test to assess the expiratory phase of breathing in a patient suspected of having an obstructive pulmonary disease. 
• Pectoriloquy — Also called whispered pectoriloquy. When the patient is asked to whisper "ninety-nine" or "one-two-three," the voices are transmitted louder and clearer. Normally, whispered voices are transmitted faintly across the air-filled lung. Increased transmission implies an airlessness.
• Tracheal — Breath sounds that are equal in length (on inspiration and expiration). Normally heard over the trachea.
  Expiratory sounds have a very loud intensity and high pitch.
• Valsalva maneuver — Straining down against a closed glottis. This technique decreases venous return to the right heart, and shortly after left ventricular volume and atrial blood pressure also fall. 
• Vesicular — Breath sound that are heard throughout inspiration, and continue into expiration. It fades away about 1/3 of the way through expiration. 
  Expiratory sounds have a soft intensity and low pitch.
• Rhonchi — Continuous, lengthy (>250 msec), and musical sounds; may not persist throughout the respiratory cycle. Sounds have a low pitch with a snoring quality.
  
  Rhonchi suggest secretions in the large airways. 
• Wheezes — Continuous, lengthy (>250 msec), and musical sounds; may not persist throughout the respiratory cycle. Sounds have a high pitch with a hissing quality.
  
  Wheezes are suggestive of a narrow airway disease such as asthma, COPD, or bronchitis.
• Whispered pectoriloquy — see pectoriloquy

Close window when finished