TABLE 12-4

Normal and Adventitious Breath Sounds

TYPE/NAME DESCRIPTION CHARACTERISTICS/CAUSES Normal Breath Sounds Vesicular Soft-intensity, low-pitched,gentle sighing sounds created by air moving through smaller airways (bronchioles and alveoli) Moderate-intensity and moderate-pitched blowing sounds created by air moving through larger airways (bronchi) High-pitched, loud, harsh sounds created by air moving through the trachea Best heard on inspiration, which is about 2.5 times longer than the expiratory phase (5:2 ratio) Equal inspiratory and expiratory phases (1:1 ratio) Over peripheral lung; best heard at base of lungs LOCATION

Bronchovesicular

Between the scapulae and lateral to the sternum at the rst and second intercostal spaces Anteriorly over the trachea; not normally heard over lung tissue

Bronchial (tubular)

Louder than vesicular sounds; have a short inspiratory phase and long expiratory phase (1:2 ratio)

Adventitious Breath Sounds Crackles (rales) Fine, short, interrupted crackling sounds; alveolar rales are high pitched. Sound can be simulated by rolling a lock of hair near the ear. Best heard on inspiration but can be heard on both inspiration and expiration. May not be cleared by coughing Continuous, low-pitched, coarse, gurgling, harsh, louder sounds with a moaning or snoring quality. Best heard on expiration but can be heard on both inspiration and expiration. May be altered by coughing Supercial grating or creaking sounds heard during inspiration and expiration. Not relieved by coughing Continuous, high-pitched, squeaky musical sounds. Best heard on expiration. Not usually altered by coughing Air passing through uid or mucus in any air passage Most commonly heard in the bases of the lower lung lobes

Gurgles (rhonchi)

Air passing through narrowed air passages as a result of secretions, swelling, tumors

Loud sounds can be heard over most lung areas but predominate over the trachea and bronchi

Friction rub

Rubbing together of inamed pleural surfaces

Heard most often in areas of greatest thoracic expansion (e.g., lower anterior and lateral chest) Heard over all lung elds

Wheeze

Air passing through a constricted bronchi as a result of secretions, swelling, tumors