Adventitious Lung Sounds

what causes wheezes?

air moving through narrowed airways

• causes: bronchospasm, swelling, or mucus

what do wheezes sound like?

musical or squeaking, continuous

when are wheezes usually heard?

often on expiration (can be on both inspiration and expiration if worse)

do wheezes clear with coughing?

usually no

what causes rhonchi?

mucus or secretions in larger airways

what do rhonchi sound like?

low-pitched, snoring or rumbling, continuous

when are rhonchi heard?

on inspiration and expiration

do rhonchi clear with coughing?

often yes (reassess after cough or suction)

what causes crackles (rales)?

air moving through fluid and the re-opening of deflated small airways/alveoli

what can crackles be further categorized as?

fine and coarse

what do crackles sound like?

discontinuous popping or crackling (fine to coarse)

what do fine crackles sound like?

tiny, high, brief (like rubbing hair near your ear)

what do coarse crackles sound like?

louder, lower, longer (like pouring milk/ripping velcro)

what causes coarse crackles?

air moving through mucus or fluid in larger airways

when are crackles heard?

often on inspiration (can also be on expiration)

what causes fine crackles?

small distal airways/alveoli snapping open near the end of inspiration

do crackles clear with coughing?

no

what causes a pleural friction rub?

inflamed pleura rubbing against the chest wall

what does a pleural friction rub sound like?

rubbing, dry, grating or creaking

when is a pleural friction rub heard?

on inspiration and expiration at a localized spot

does a pleural friction rub clear with coughing?

no (and it is often painful with breathing)

what causes stridor?

1. upper-airway narrowing or obstruction (larynx/trachea)

2. a foreign body in airway

3. laryngospasm (larynx shut close)

what does stridor sound like?

harsh, loud, high-pitched “crowing”

when is stridor heard?

mainly on inspiration

how urgent is stridor?

emergency—airway at risk; act fast

what does an absence of breath sounds suggest?

a collapsed lobe/lung or a surgically removed lobe/lung