Alternate Names: Rhonchi; Rales; Chest sounds - lung; Auscultation of the lungs; Lung sounds - abnormal

Considerations: The lung sounds are usually examined by listening with a stethoscope.

Normal lung sounds occur in all parts of the chest area, including above the collarbones and as low as the bottom of the rib cage. When listening to the lungs, the categories of findings include normal breath sounds, decreased or absent breath sounds, and abnormal breath sounds.

Absent or decreased sounds are inaudible (absent) or reduced in loudness (decreased) when the lungs are examined with a stethoscope. They reflect reduced airflow to a portion (segment) of the lungs, over inflation of a portion of the lungs (such as with emphysema), air or fluid around the lungs, or sometimes increased thickness of the chest wall.

There are several types of abnormal breath sounds: rales, rhonchi, and wheezes are the most common. Wheezing can sometimes be heard without a stethoscope, and other abnormal sounds are sometimes also loud enough to be detected with the unaided ear.

Rales (crackles or crepitations) are small clicking, bubbling, or rattling sounds in a portion of the lung. They occur when air moves through fluid-filled airways. Rales are further described as moist, dry, whistling, fine, coarse, or other descriptions.

Rhonchi are sounds with a loud, low, coarser sound. They may be further described as musical, groaning, snoring, and so on. They are produced when the larger airways are filled with fluid.

Wheezes are high-pitched, musical sounds produced by narrowed airways, occurring during expiration.

Common Causes:

• lung tumors
• foreign body obstruction of the airway
• mucus plugs in the airway
• emphysema
• asthma
• obesity (thick chest wall)
• extremely muscular people (thick chest wall)
• adult respiratory distress syndrome (ARDS)
• bronchiectasis
• chronic bronchitis
• acute bronchitis
• interstitial fibrosis
• Legionnaire’s disease
• lung abscess
• pneumonia
• atypical pneumonia
• psittacosis
• pulmonary edema
• pulmonary tuberculosis
• sarcoidosis
• tracheobronchitis

Home Care: Consult your health care provider.

Call If:

• use of accessory muscles or other signs of increased breathing work (such as retractions, nasal flaring, and cyanosis) are also present. This is an emergency symptom!
• difficulty breathing or shortness of breath occur; these indicate a potentially emergency condition!
• wheezing or other abnormal sounds persist longer than a few hours.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting an abnormal lung sound in detail may include:

• time pattern
  • When did it start?
  • How long did it last?
  • Is there a pattern to the occurrences?
• quality
  • How would you describe it?
• relieving factors
  • What makes it better?
• aggravating factors
  • What makes it worse?
• other
  • What other symptoms are also present?
  • Is there any coughing?
  • Is there any difficulty breathing?

• lung scan
• chest X-ray
• analysis of a sputum sample (sputum culture, sputum gram stain)