PEDIA ROTATION  Described as being similar to the sound of wood

burning in a fireplace
BREATH SOUNDS  Can be heard in both phases of respiration
(inspiration and expiration)
WHEEZING (EXPIRATORY)
 Early inspiratory and expiratory crackles are classic
 Wheezes are caused by narrowing of the airways
lung exam findings in chronic bronchitis
 Seen in asthma or COPD
 Late inspiratory crackles can suggest pneumonia,
 Continuous lung sounds congestive heart failure, or atelectasis
 They have a musical quality, which can have either a  Fine crackles can best be auscultated at the lung
high or low pitch depending on the extent of the bases
airway obstruction
 Differential
 Think of it like whistling through a narrow tube o CHF
 High pitched wheezes may sound similar to o Pneumonia
squeaking
o Atelectasis
 Lower pitched wheezes have a snoring or moaning
quality
COARSE CRACKLES (AKA RALES)
 Heard during expiration and clear breath sounds
 They have a popping characteristic sound that is low-
during inspiration
pitched
 Because of the airway obstruction, the expiratory
 Sometimes described as having a “bubbling” sound
phase can be prolonged
quality
 Wheezing can be heard throughout the chest wall
 Compared to fine crackles, coarse crackles are low-
 This can be seen in mild to moderate asthma pitched, louder and last longer in duration
 In some cases, such as in certain viral infections,  Coarse crackles can be heard in patients with
wheezing can be heard in isolated patches across the o chronic bronchitis
chest wall
o bronchiectasis,
VESICULAR BREATH SOUNDS o pneumonia
 These are normal breath sounds o severe pulmonary edema
 They are the most commonly auscultated breath  It is produced by air passing through airways which
sounds undergo intermittent opening and closing
 Described as soft with a low pitch  Coarse crackles can be heard in both phases of
 The sound become even softer during expiration respiration (inspiration and expiration)
 Inspiratory time is longer than expiratory time.  Compared to fine crackles, which are heard best at
Approximately 3:1 the lung bases, coarse crackles have no predilection
for any particular area of the lung
 Can be best heard in most areas of the lungs but are
most prominently heard at the lung bases and
Bronchovesicular breath sounds
periphery
 Described as having a mid-range pitch and intensity
RONCHI  Just like vesicular and bronchial breath sounds, these
 Continuous breath sounds heard during inspiration are also normal breath sounds
and expiration  Unlike vesicular and bronchial breath sounds,
 Compared to wheezing, they are lower in pitch inspiratory time is often equal to expiratory time (1:1)
 The sound often comes from copious secretions in  Intermediate or mixture of:
large airways or bronchi o Higher pitched bronchial sounds and low
 Often heard in patients with pitched vesicular sounds
o COPD  They are considered normal breath sounds
o Cystic fibrosis  Can be heard throughout the lung fields, but can be
o Bronchiectasis commonly heard in the upper third of the chest
o Pneumonia
Bronchial Breath Sounds
 As air rushes past these secretions, it creates  Described as hollow or tubular sounds
turbulent flow leading to the classic description of
 They are higher pitched compared to vesicular breath
ronchi as snoring, gurgling or rumbling
sounds
 Ike wheezing, ronchi occur because of narrowing of
 Generally louder than vesicular sounds
airways
 Inspiration and expiration have the same or very
 Ronchi is sometimes referred to as low pitched
similar duration
wheezes
 They are considered normal breath sounds if
 Unlike wheezing, ronchi can usually clear with
auscultated over the trachea
coughing
 Ronchi are caused by secretions in large airways  If heard in the peripheral of the lungs, this could be a
 They are heard loudest towards the center of the finding which is abnormal and suspicious for
chest instead of the periphery pneumonia, pleural effusions or atelectasis

FINE CRACKLES (AKA RALES)