Points to be noted in auscultation of respiratory system.
Breath sounds, vocal resonance and adventitious sounds are analysed in the following
way:
Breath sounds
– Vesicular (rustling in character, intensity and duration of inspiration is greater
than expiration, and no gap in between inspiration and expiration).
– Bronchial (blowing, hollow or guttural in character, intensity of expiration is
greater than inspiration, and a definite gap is present in between inspiration and
expiration). It has three types:
• Tubular (high-pitched, and found in consolidation, collapse with a patent
bronchus, and sometimes above the level of pleural effusion)
• Cavernous (low-pitched, and found over a superficial, big, empty cavity in
lung connected with a patent bronchus)
• Amphoric [low-pitched with tones and overtones or with a metallic tone, and
is found in brochopleural fistula (i.e., open pneumothorax)].
– Bronchovesicular (the term is rarely used nowadays. Here, inspiration is like
vesicular, while expiration is like bronchial in character. In health, it is found
over right infraclavicular area and interscapular area (it is the area of 'root or
hilum of both the lungs' at the level of T5, T6, T7 vertebrae on both sides).
Pathologically, this type may be found in early consolidation or collapse of the
lung).
Vocal resonance
– Quantitative change
• Increased (bronchophony and whispering pectoriloquy are common in
consolidation)
• Decreased (pleural effusion, pneumothorax, thickened pleura)
– Qualitative change (nasal intonation is added in vocal resonance and is known
as aegophony; common in consolidation and while auscultating above the level
of pleural effusion).
Adventitious sounds
– Crepitations/crackles
• Fine (early pneumonia, LVF)
• Coarse (resolving pneumonia, bronchiectasis)
– Rhonchi/wheezes
• Monophonic (foreign body or tumour in bronchus)
• Polyphonic (dynamic compression of bronchus by bronchial asthma or COPD)
– Pleural rub (found in pleurisy i.e., from tuberculosis, pneumonia, bronchogenic
carcinoma).
NB: Go to the bedside: with the help of your teachers, try to be acquainted with the
special 'characters' of the sounds like:
Rustling character (sound like dry leaves blown by the wind) of vesicular breath
sound—the normal breath sound in health.
Blowing or hollow character of bronchial breath sound e.g., consolidation (just
practice to auscultate over trachea of a person, and train your ear with the character
of the sound, which is just bronchial).
Nasal intonation of a sound mimicking bleating of a goat in aegophony e.g., in
upper border of pleural effusion or consolidation
Whispering words seem louder and heard distinctly by the clinician in whispering
pectoriloquy, e.g., in consolidation. Bronchophony is simply louder vocal resonance.
Uninterrupted, musical, whistling sound of rhonchi (wheezes) in smaller airway
obstruction, e.g., bronchial asthma.
Discontinuous bubbling or crackling sound of crepitations produced usually by
passage of air through exudate-filled bronchi, bronchioles or alveoli, e.g., in acute
bronchopneumonia, LVF.
Leathery, scratchy or creaking sound of friction of visceral and parietal pleura in
pleurisy gives rise to pleural rub. It is commonly found over antero-inferior part of
lateral chest wall or lower part of back of the chest; better heard by pressing the
chest piece of the stethoscope over the chest wall (remember, pericardial rub also
increases by pressing the stethoscope).
Breath sounds, vocal resonance and adventitious sounds are analysed in the following
way:
Breath sounds
– Vesicular (rustling in character, intensity and duration of inspiration is greater
than expiration, and no gap in between inspiration and expiration).
– Bronchial (blowing, hollow or guttural in character, intensity of expiration is
greater than inspiration, and a definite gap is present in between inspiration and
expiration). It has three types:
• Tubular (high-pitched, and found in consolidation, collapse with a patent
bronchus, and sometimes above the level of pleural effusion)
• Cavernous (low-pitched, and found over a superficial, big, empty cavity in
lung connected with a patent bronchus)
• Amphoric [low-pitched with tones and overtones or with a metallic tone, and
is found in brochopleural fistula (i.e., open pneumothorax)].
– Bronchovesicular (the term is rarely used nowadays. Here, inspiration is like
vesicular, while expiration is like bronchial in character. In health, it is found
over right infraclavicular area and interscapular area (it is the area of 'root or
hilum of both the lungs' at the level of T5, T6, T7 vertebrae on both sides).
Pathologically, this type may be found in early consolidation or collapse of the
lung).
Vocal resonance
– Quantitative change
• Increased (bronchophony and whispering pectoriloquy are common in
consolidation)
• Decreased (pleural effusion, pneumothorax, thickened pleura)
– Qualitative change (nasal intonation is added in vocal resonance and is known
as aegophony; common in consolidation and while auscultating above the level
of pleural effusion).
Adventitious sounds
– Crepitations/crackles
• Fine (early pneumonia, LVF)
• Coarse (resolving pneumonia, bronchiectasis)
– Rhonchi/wheezes
• Monophonic (foreign body or tumour in bronchus)
• Polyphonic (dynamic compression of bronchus by bronchial asthma or COPD)
– Pleural rub (found in pleurisy i.e., from tuberculosis, pneumonia, bronchogenic
carcinoma).
NB: Go to the bedside: with the help of your teachers, try to be acquainted with the
special 'characters' of the sounds like:
Rustling character (sound like dry leaves blown by the wind) of vesicular breath
sound—the normal breath sound in health.
Blowing or hollow character of bronchial breath sound e.g., consolidation (just
practice to auscultate over trachea of a person, and train your ear with the character
of the sound, which is just bronchial).
Nasal intonation of a sound mimicking bleating of a goat in aegophony e.g., in
upper border of pleural effusion or consolidation
Whispering words seem louder and heard distinctly by the clinician in whispering
pectoriloquy, e.g., in consolidation. Bronchophony is simply louder vocal resonance.
Uninterrupted, musical, whistling sound of rhonchi (wheezes) in smaller airway
obstruction, e.g., bronchial asthma.
Discontinuous bubbling or crackling sound of crepitations produced usually by
passage of air through exudate-filled bronchi, bronchioles or alveoli, e.g., in acute
bronchopneumonia, LVF.
Leathery, scratchy or creaking sound of friction of visceral and parietal pleura in
pleurisy gives rise to pleural rub. It is commonly found over antero-inferior part of
lateral chest wall or lower part of back of the chest; better heard by pressing the
chest piece of the stethoscope over the chest wall (remember, pericardial rub also
increases by pressing the stethoscope).