LUNG SOUNDS

-ASWIN VIJAY

Lung sounds
Breath sounds originate from the turbulent airflow in the

larger airways
When these vibrations transmitted through the lung tissue and
the thoracic wall to the surface where they may be heard with
the aid of a stethoscope
Breath sounds have intensity and quality
It may be normal , reduced or increased
Quality of normal breath sound is vesicular

BREATH SOUNDS

NORMAL
ABNORMAL

NORMAL
BRONCHIAL
VESICULAR
BRONCHOVESICULAR

BRONCHIAL SOUNDS
Consist of a full inspiratory and expiratory phase with the
inspiratory phase
usually being louder
normaly heard over trachea and larynx
bronchial sounds normaly NOT heard over the thorax

VESICULAR SOUNDS
Consist of quiet wispy inspiratory phase followed by a short

almost silent expiratory phase

Heard over the thorax

vesicular breath sound

inspiration

expiration
-breath sounds throughout
inspiration and early

expiration
-rustling quality
-no pause between
inspiration and
expiration

Bronchovesicular sounds
Normaly heard over the Right interscapular and Right

infraclavicular region due to the proximity of the bronchus

Abnormal Breath Sounds

1.Bronchial breathing
Throughout inspiration and expiration
Pause between inspiration and expiration
Aspirate in quality
Depending on the pitch 3 types of bronchial breathing:
1. Tubular Breathing
2. Cavernous Breathing
3. Amphoric Breathing

Tubular breathing
high pitched bronchial breathing in consolidation
Mechanism:

- high pitched sounds at alveolar duct is conducted to

chest wall without modification by the alveoli due to
consolidation

Cavernous breathing
low pitched bronchial breathing in lung cavity
Mechanism:

-High pitched sounds at alveolar duct will become

low pitched in the cavity and conducted to the surface without
modifications.

Amphoric breathing
Low pitched bronchial breathing with super added high pitched

overtones producing a metallic quality on auscultation

Mechanism:
-high pitched sounds at alveolar duct become low pitched in
the large communicating cavity
-reflected sounds from the wall of the cavity is high pitched
-producing the combination of low pitched sounds with high
pitched overtones in amphoric breathing
-seen in large communicating cavity and bronchopleural fistula.

Adventitious Sounds
CREPITATION [CRACKLES]
Non continuous sounds with a crackling quality
Better heard during inspiration
Mechanism:- due to sudden opening of previously closed small airways
on
inspiration.
-due to collapse of peripheral airways on expiration
3 types:
Fine crepitations - in early stage of consolidation and fibrosis alveolitis
Medium crepitations- in pulmonary edema
Coarse crepitation-resolving pneumonia, bronchiectasis, lung abscess.

Crepitation depends on the timing of respiratory phase:

1. Early inspiratory: Bronchitis-small airway disease
2. Late inspiratory: Fibrosing alveolitis, early consolidationparenchymal disease
3. Expiratory and inspiratory crepitation: Bronchiectasis , and
pulmonary edema
4. Coarse crackles/crepitation[death rattle] occur as a
terminal event in pulmonary edema

RHONCHI/WHEEZE
Dry continuous sound
Musical sounds associated with airway narrowing.
Produced by the passage of air through narrow bronchus
Heard better in expiration because airways normally dilate

during inspiration and narrow on expiration.

Inspiratory wheeze implies severe airway narrowing.
Depending on pitch 2 types:
1. Low pitched(Sonorus): arising from large airways
2. High pitched (Sibilent): arising from small airways

CAUSES OF RHONCHI
Bronchial asthma
COPD
Cardiac asthma
Tropical pulmonary eosinophilia

Pleural Rub
Superficial grating sound
Produced by rubbing of inflamed parietal and visceral

pleura
Associated with pleuritic pain
Not altered by coughing
Heard only on deep breathing( end of inspiration and
beginning of expiration)
Heard in pneumonia or pulmonary vasculitis
If pleura adjacent to pericardium involved, a
pleuropericardial friction rub also heard

Succussion splash
Tinkling sound
By mixing of air and fluid in hydropneumothorax while shaking

the patient
First percuss out the air fluid level
Keep the chest piece over the area
Shake the patient suddenly by holding the opposite shoulder
of the patient

Vocal Resonance
Gives information about the lungs ability to transmit vibrations of sounds.
Normal lung filter high pitched sounds and transmit low pitched

components of speech
Auscultate over the chest while the patient speaks the syllables 1,2,3 or
99
Vocal resonance
Normal- means as if the syllables are produced at the chest wall
increased as if the syllables are produced between chest wall and ear
piece-as in consolidation
Bronchophony-means the syllables are produced right into the ear-in
consolidation and cavity

Aegophony- bronchophony with a nasal or bleating quality-in

consolidation with mild pleural effusion and cavity.

Reduced- intensity less when comparing to identical area on
opposite side- as in pleural effusion, pneumothorax,
emphysema.

Vocal fremitus
Detected with the hand on the chest wall

THANK YOU