Auscultation: Listening to breath
sounds with a stethoscope
Normal Breath Sounds and Their
Locations
Abnormal Breath Sounds:
Diminished or Absent
Increased distance between aerated
lung and chest wall:
Pneumothorax, Pleural effusion,
Atelectasis, Obesity around thorax
Decreased or absent airflow
Airflow obstruction (eg asthma),
Hyperinflation (COPD), Malpositioned ET
Tube
Abnormal Breath Sounds:
Bronchial or Bronchovesicular
in abnormal part of the lung
Lung has become more solid and less
aerated in these areas
Consolidation, eg, pneumonia, or
Atelectasis
Abnormal Breath Sounds:
Adventitious Sounds
Wheeze – continuous musical sounds
heard mostly during expiration
May be also heard on inspiration
Caused by a sudden change in airway
caliber
Edema, spasm, secretions, foreign body
Abnormal Breath Sounds:
Adventitious Sounds
Crackles – discontinuous sound heard
mostly on inspiration
Caused by small airways and alveoli
popping open or from secretions in very
large airways
Lets all listen in
Condition
Atelectasis
Pneumothorax
Pleural Effusion
COPD
Pulmonary
Consolidation
Fibrosis
Pulmonary
Edema
Chest
Excursion
Fremitus
Percussion Breath
Sounds
Chest Physical Exam: Case Study
A patient is admitted with fever and cough.
Auscultation reveals bronchial breath
sounds in the lower chest posteriorly and
normal vesicular breath sounds in the rest
of the lower thorax.
Chest Physical Exam: Case Study
A patient is scheduled for inguinal hernia
surgery. Observation reveals increased AP
diameter and use of accessory muscles for
breathing. Auscultation yields diminished
breath sounds in the upper and middle
chest and absent breath sounds in the
lower chest.
Chest Physical Exam: Case Study
A 12 year patient in the ER with respiratory
distress has bilateral wheezes throughout both
lung fields and prolonged expiration. A-P
diameter of the chest is increased.
Chest Physical Exam: Case Study
A ventilator patient suddenly becomes diaphoretic
and tachycardic. The pressure limit alarm on the
ventilator is sounding on every breath. Auscultation
shows absent breath sounds on the left and
percussion yields hyperresonance on the left.