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Introduction
Chest auscultation is a key component of a respiratory examination. Identifying and recognising various lung sounds is crucial to determining the diagnosis and guiding investigations and management.
This article will cover the clinical features of common lung sounds and their underlying aetiology.
Chest auscultation
When auscultating the chest, it is important that you have a systematic approach that allows you to compare each area on both the left and the right as you progress.
Normal lung sounds
Vesicular breathing sounds are low-pitched sounds, heard primarily on inspiration. These are the normal quality of breath sounds in healthy individuals.
Bronchial breathing sounds are harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal, and there is a pause between. This is normal if auscultating near the trachea, but in other areas is associated with consolidation.
Wheeze
Clinical features
Wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. It is caused by turbulence in narrowed airways.
Wheeze can be described as monophonic (constant frequency) or polyphonic (varied frequency), as well as predominantly inspiratory or expiratory (more common).
Monophonic wheeze results from large airway narrowing, and polyphonic wheeze from widespread narrowing of smaller airways.
Aetiology
Wheeze is typically seen in:
- Asthma:Â polyphonic expiratory wheeze
- Chronic obstructive pulmonary disease:Â polyphonic expiratory wheeze
- Bronchiectasis:Â polyphonic expiratory wheeze
- Foreign body/tumour: fixed monophonic wheeze
Stridor
Clinical features
Stridor is a high-pitched extra-thoracic inspiratory breath sound resulting from turbulent airflow through narrowed upper airways.
Aetiology
Stridor has a wide range of causes, including:
Coarse crackles
Clinical features
Coarse crackles are discontinuous, brief, popping lung sounds. They are typically heard on inspiration due to the opening of the small airways filled with fluid, mucous or pus.
Aetiology
Coarse crackles are typically seen in:
Fine end-inspiratory crackles
Clinical features
Fine crackles are often described as sounding similar to the noise generated when separating velcro. They are typically heard at the end of inspiration.
Aetiology
Fine end-respiratory crackles are associated with:
- Pulmonary fibrosis
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