AUSCULTATION OF THE

LUNGS

AUSCULTATION

DIRECT

MEDIATED

DIRECT AUSCULTATION =
TRANSMITTED VOICE

TRANSMISSION OF VOICE (normal

speaking, ninety-nine)
- Normally= muffled and indistinct
- BRONCHOPHONY= LOUD, CLEAR

Consolidation sdr, with free bronchi

Cavitary sdr. with free bronchi
Mediastinal sdr

DIRECT AUSCULTATION =
TRANSMITTED VOICE

Transmission of ee sound
- Normally= long, muffled ee
- EGOPHONY= E-TO-A CHANGE
Consolidation sdr.
Pleural effusion, medium quantity

DIRECT AUSCULTATION =
TRANSMITTED VOICE
AMPHORIC VOICE
- Pneumothorax
- Cavitary sdr (outward, big cavities with peripheral
consolidation and small free bronchi)

WHISPERED VOICE=
- Normally= muffled, if heard at all
- PECTORILOQUY= loud, clear
-

Pneumothorax
Pleural effusion, medium quantity
Consolidation sdr, free bronchi

MEDIATED AUSCULTATION
1.

INSPIRATION/ EXPIRATION RATIO

2.

BREATH SOUNDS (OR SOUNDS THAT

REPLACE THEM)

3.

ADDED SOUNDS

4.

AUSCULTATION OF TACHEAL ND
BRONCHIAL SOUNDS

INSPIRATION/ EXPIRATION RATIO

PROLONGED INSPIRATION
(superior) OBSTRUCTIVE sdr
Larynx
Trachea

Principal bronchi

PROLONGED EXPIRATION
Hyperinflation sdr.
Bronchospasm
Pulmonary edema
Bronchopneumonias

VESICULAR SOUND

EXAGERATED
HARSH

DIMINUATED
ABOLISHED

VESICULAR SOUNDS

EXAGERATED compensatory hyperfunction of one

lung

Pleural effusion

Massive atelectasias
Important infiltrative lesions

HARSH

Diminution of the caliber of bronchi

Edema of the bronchial mucosa

Adherent bronchial secretions

VESICULAR SOUND

DIMINUATED

Larynx stenosis

Bronchial stenosis

Limitation of pulmonary expansion (pleurisy,

pleuritis)

Consolidation sdr

Permanent hyperinflation sdr

Pleural effusion, small/ medium quantity

VESICULAR SOUND

ABOLISHED ( RESPIRATORY SILENTIUM)

Massive pleural effusion

Pneumothorax

Massive consolidation sdr

Bronchial foreign bodies

REPLACEMENT OF VESICULAR SOUNDS

MURMURS
TUBAR
PLEURETIC
AMPHORIC

CAVERNOUS

MURMURS
TUBAR (BRONCHO-VESICULAR SOUND)
Consolidation sdr rounding one big, free bronchi
PLEURETIC (BRONCHIAL SOUND)

Pleurisy, medium quantity

AMPHORIC (I)

Cavitary sdr (superficial big cavities with smooth inner

walls)

CAVERNOUS (I+E)

Cavitary sdr (>6 cm, profound))

ADDED SOUNDS

BRONCHO-PULMONARY
RALES

PLEURAL
PLEURAL RUB

RALES
DRY, CONTINUOUS

RONCHI

WHEEZES

MOIST, DISCONTINUOUS

CRACKLES

FINE CRACKLES

CAVERNOUS

DRY RALES
RONCHI

LOW PITCH

HARSH QUALITY, SNORRING

INSIRATION + EXPIRATION

MODIFICATION WITH COUGHING: IN

LOCALIZATION, PITCH AND INTENSITY

BIG CALLIBER BROCHI

DRY RALES
WHEEZES

HIGH PITCH

MUSICAL QUALITY, WHISTLING

INSIRATION + EXPIRATION

MODIFICATION WITH COUGHING: IN

LOCALIZATION, PITCH AND INTENSITY

MEDIUM AND SMALL CALLIBER BRONCHI

MOIST RALES
CRACKLES

UNEVEN: small, medium, coarse

HIGH PITCH

BLOWING AIR THROUGH A STRAW INTO A GLASS OF

WATER

MICI (FINE), MIJLOCII, MARI (GROASE)

INSPIRATION + the first part of EXPIRATION

MODIFICATION WITH COUGHING: IN LOCALIZATION,

PITCH AND INTENSITY

SMALL (4TH ORDER) BRONCHI AND BRONCHIOLES

MOIST RALES
FINE CRACKLES

The most dry of moist rales

HIGH PITCH

RUBBING THE HAIR NEAR THE EAR

IN THE SECOND HALF OF INSPIRATION

INCREASES AFTER COUGHING

ALVEOLI

MOIST RALES

BACKWARDS CRACKLES

More moist, uneven, coarse-fine crackles: con be

confounded with coarse crackles
INSPIRATORY
PNEUMONIA- REGRESION PHASE

RECUMBENCY CRACKLES

AFTER PROLONGED BED REST

Disappears after ample breathing

MOIST RALES
CAVERNOUS RALES
RESEMBLES COARSE CRACKLES
Coarse
Uneven
Few in number

PLEURAL FRICTION RUB

SUPERFICIAL (near the ear)

Dry quality

INSPIRATION + EXPIRATION

NO MODIFICATION AFTER COUGHING

Becomes louder when pressing the stethoscope

Can have an equivalent on palpation

PLEURAL INFLAMATORY DISORDERS

TRACHEAL SOUND

Modification in inspiration and expiration: summarizes

the bronchial rales all over both lungs