Abnormal lung sounds (what they sound like + what they usually mean). By DrRamonReyesMD

 

abnormal lung sounds (what they sound like + what they usually mean).

👉Crackles (rales) — “popping / Velcro”

 • Fine crackles (high-pitched, end-inspiratory; like hair rubbing near ear)

→ Pulmonary edema/heart failure, interstitial lung disease/fibrosis, pneumonia (early), atelectasis (can clear with cough)

 • Coarse crackles (lower-pitched, “bubbly”; can change after coughing)

→ Bronchiectasis, COPD with secretions, pneumonia, pulmonary edema (later)

👉Wheeze — “musical, high-pitched” (usually expiratory)

 • Diffuse polyphonic wheeze

→ Asthma, COPD, bronchospasm (also allergic reaction/anaphylaxis)

 • Monophonic/localized wheeze

→ Focal obstruction (mucus plug, tumor, foreign body)

 • Silent chest (very little air movement despite distress)

→ Impending respiratory failure in severe asthma (emergency)

👉Rhonchi — “low-pitched snoring/gurgling”

 • Often clears or changes with coughing

 • → Large airway secretions: chronic bronchitis, bronchiectasis, pneumonia with mucus

👉Stridor — “harsh, loud” (usually inspiratory) heard over neck

 • → Upper airway obstruction: croup, epiglottitis, foreign body, laryngeal edema

 • Red flag if with drooling, tripod position, or severe distress.

👉Pleural friction rub — “leathery creak”, worse with deep breaths

 • → Pleuritis (viral pleurisy), pneumonia near pleura, pulmonary embolism, TB, autoimmune pleuritis

 • Usually doesn’t clear with cough.

👉Diminished/absent breath sounds

 • Unilateral absent

→ Pneumothorax, large pleural effusion, mainstem intubation/obstruction

 • Diffuse decreased

→ Severe COPD/emphysema, shallow breathing, obesity/hypoventilation

👉Bronchial breath sounds (abnormal if heard in peripheral lung)

 • Loud, high-pitched, with a gap between inspiration and expiration

 • → Consolidation (classically lobar pneumonia)

👉Voice transmission changes (helpful bedside add-ons)

 • Egophony (“E” → “A”)

→ Consolidation, sometimes top of pleural effusion

 • Bronchophony (spoken words sound louder/clearer)

→ Consolidation

 • Whispered pectoriloquy (whispers sound clear)

→ Consolidation

 • Decreased voice sounds

→ Pleural effusion or pneumothorax

Quick pattern recognition

 • Wheeze = airway narrowing (asthma/COPD)

 • Crackles = fluid or stiff alveoli (HF, pneumonia, fibrosis)

 • Rhonchi = secretions (bronchitis)

 • Stridor = upper airway obstruction (urgent)

 • Absent sounds = air/ fluid outside lung or severe hyperinflation

#Auscultation #lungs