a u s c u l t a t i o n    t u t o r
Late-inspiratory squeaks
t h e    l u n g s

Diagnosis

Findings on Auscultation

Company it Keeps
Normal
  • Breath sounds symmetric
  • Vesicular throughout
  • Bronchial central
  • Minimal adventitious sounds
  • May have wheezes with forced expiration
  • Nonspecific
  • Mild retraction inhalation
  • Mild bulge exhalation
Consolidation
  • Crackles over area
  • Cough productive of yellow-green, often
    rust streaked, sputa
Open airways
  • Rhonchus or wheeze
  • Late inspiratory crackles
  • Breath sounds present, bronchial in nature
  • Dullness
  • Increased tactile fremitus
Consolidation, obstructed
  • Diminished breath sounds
  • Crackles present
  • Breath sounds are bronchial
  • Dullness
  • Decreased to absent tactile fremitus
Pleural effusion
  • Diminished breath sounds
  • Bronchial breath sounds at superior rim
  • Dullness
  • Decreased tactile fremitus
  • Focal intercostal bulge inhalation and
    exhalation
Asthma/reactive airways
  • Diffusely diminished breath sounds
  • Vesicular breath sounds
  • Prolonged expiratory phase
  • Expiratory wheezes
  • In moderately severe, expiratory and
    inspiratory wheezes
  • Expiratory stridor-type sounds
  • Eczema
  • Accentuated retraction with inspiration
Severe asthma
  • Paucity of wheezes
  • Wheezes may become inspiratory and
    expiratory
  • Diffusely diminished breath sounds
  • Early inspiratory crackles
  • Somnolence because of CO2 narcosis
  • Use of sternocleidomastoid muscles
  • Use of scalene anterior muscles
Upper airway compromise
  • Diffusely diminished breath sounds
  • Vesicular breath sounds
  • Prolonged expiratory phase
  • Inspiratory (usually holoinspiratory) stridor
  • Position of “sniffing the flowers”
  • Accentuated retraction with inspiration
Pneumothorax
  • Locally diminished breath sounds
  • Rub adjacent may be present
  • Tympany over area
  • If tension, trachea deviated to (pushed
    toward) other side
  • If tension, hypotension, sudden cardiac
    collapse
Emphysema
  • A few wheezes
  • Diffusely diminished breath sounds
  • Early inspiratory crackles if severe
  • Tympany throughout
  • Increase anteroposterior diameter
  • Lowered and flattened hemidiaphragms
Chronic bronchitis
  • Normal intensity breath sounds
  • Diffuse wheezes and rhonchi
  • Early inspiratory crackles if severe
  • Chronic cough
  • Productive cough
  • cor pulmonale, clubbing, right S3
Bronchiectasis
  • Midinspiratory crackles over area
  • Bronchial breath sounds over area
  • Dullness over area
  • Increased tactile fremitus
  • Chronic cough produces yellow-green
    sputa
Interstitial lung disease
  • Diffuse, dry, fine crackles
  • Clubbing
  • Often concurrent
  • Pleural disease
Pulmonary edema
  • Lower zones, late coarse crackles
  • A few wheezes, diffuse
  • Peripheral edema
  • Gallop—S3 or S4
  • Cardiomegaly
  • Laterally displaced, PMI, lift or heave
  • Increased JVP
Situs inversus
  • Decreased breath sounds right
  • Anterior
  • Decreased tactile fremitus, right anterior
  • Dullness to percussion, right anterior
  • Liver scratched and palpated in left
    midclavicular line
  • If Kartengener's, recurrent pneumonias
Ausculatory Descriptors of Common Lung Diagnoses
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