Pulmonology 2

Lung Sound *.Wav Files

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Normal Breath Sounds

• A Trachial Breath Sound

  The Tracheal Breath Sound has the following characteristics :

   

  1. An I:E Ratio : 1:1 with a pause in between inspiration & expiration
  2. Thoracic Geography : over the trachea on the throat
  3. Sound Characteristics : high pitched, tubular, hollow sound
  4. Indication : pneumonia, atelectasis, fluid infiltration

   

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• A Bronchial Breath Sound
  

  The Bronchial Breath Sound has the following characteristics :

   

  1. An I:E Ratio : 1:1 or 1:1 1/4 with a pause in between inspiration & expiration
  2. Thoracic Geography : over the manubrium of the sternum
  3. Sound Characteristics : high pitched, tubular, hollow sound
  4. Indication : pneumonia, atelectasis, fluid infiltration

   

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• A Vesicular Breath Sound

  The Vesicular Breath Sound has the following characteristics :

   

  1. An I:E Ratio : 1:0 or 1:1/4 with no pause in between inspiration & expiration
  2. Thoracic Geography : everywhere on the thoracic wall
  3. Sound Characteristics : low pitched, soft rustling sound
  4. Indication : pneumonia, atelectasis, fluid infiltration

   

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• A Bronchovesicular Breath Sound

  The Bronchovesicular Breath Sound has the following characteristics :

   

  1. An I:E Ratio : 1:1 or 1:1 1/4 with a pause in between inspiration & expiration
  2. Thoracic Geography : sternocostal margins, over the verbral column between the scapulae
  3. Sound Characteristics : high pitched, tubular, hollow sound
  4. Indication : pneumonia, atelectasis, fluid infiltration

Adventitious Sounds

 

Rales or crackles is a sound that is a discontinuous sound that is like a milkshake being sucked up through a straw, or popcorn popping in a popcorn popper, or like aerial bombs going off on the 4th of July, or the sound that you hear when burning wood crackles and pops in a fireplace. When fluid or mucus collects in the peripheral portions of the lung, the alveoli collapse and the walls of the alveoli stick together. Then, when the patient attempts to inhale and creates a large negative, the alveolar walls are forced to pop open and the crackle or the popping sound is created. This is a sound heard during inspiration. If it is heard anywhere on the chest wall, it is an ominous sound. It is indicative of a pneumonia or an atelectatic lung.

 

• Fine Rales or Crackles

   

• Medium Rales or Crackles

   

• Course Rales or Crackles - Case # 1

   

• Course Rales or Crackles - Case # 2

   

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  Pleural Friction Rubs are created when the visceral and parietal pleurae become inflammed and roughened. The inflammed membranes will stick together. As the therapist auscultates the chest wall, the rubbing together of the inflammed membranes will cause the patient to experience pain and stop breathing - a maneuver called splinting. The pain is caused by the sticking together of the membranes and the pulling apart of those membranes with continued breathing. Once the membranes slip past one another and break free from the sticking point, then the patient is pain-free and inhalation or exhalation can continue. The sound that a pleural friction rub makes is a leather-on-leather type of sound. These sounds can be heard at the same points in the inhalatory and the exhalatory cycles.

   

• Pleural Friction Rub - Case # 1

   

• Pleural Friction Rub - Case # 2

   

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  The Death Rattle is an ominous sound that generally describes a patient with lungs that are filling up with fluid. The death rattle is produced by passing air through secretions. It can generally be heard eminating from a patient without the use of a stethoscope. It often can be heard from the hall as you pass the patient's room.

   

• Death Rattle

   

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  Stridor is a high pitched wheezing that is caused by the obstruction of the trachea either by inflammation or an object. Just enough air passes the obstructed point to cause a high-pitched whining wheeze. In children, stridor is most frequently caused by croupe, a viral infection that causes the tracheal membranes to swell to a near-closed position. The wheeze is produced much like a wind instrument produces sound through a wooden reed. In children, croupe can be a life-threatening condition which can cause death if the trachea closes off to tightly. Other reasons why stridor is seen very often in children is due to their propensity to inhale a toy into their trachea.

   

• Stridor - Case # 1 - Mild Early Stridor

   

• Stridor - Case # 2 - Advanced Severe Stridor

   

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• Sonorous Rhonchus or Wheeze

  Rhonchi or Wheezes appear in two varieties - a sibilant wheeze and a sonorous wheeze. The wheezes are considered to be central airway sounds caused by air passing through mucus plugs in the upper divisions of the tracheobronchial tree. The sibilant wheeze is a high-pitched whining type of wheeze much like the sound that hump-back whales make as they migrate. The sonorous wheeze is a snoring type of sound.

   

   

   

• Sibilant Rhonchus or Wheeze - Case # 1

   

• Sibilant Rhonchus or Wheeze - Case # 2

   

• Early Wheezes In An Asthmatic Patient

   

• Severe Sibilant Wheezes In An Asthmatic Patient

   

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Vocal Sounds

• Egophony

  Egophony is the Greek word for "Voice of the Goat". This sound is the "EEEEE" to "AAAAA" conversion that a person will make when being asked to say "EEEEE" while the auscultator listens to the lungs which is heard by the auscultator as "AAAAA" through the stethoscope.

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  Whispered Pectoriloquy is the sound that is heard through the stethoscope by the auscultator when the patient whispers a word or a number. Normally, whispered sounds are not heard through the chest wall. Because of fluid buildup in the alveolar regions of the lung, the whispered sound can be heard distinctly.

   

   

• Whispered Pectoriloquy