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a u s c u l t a t i o n t u t o r

Amphoric breath sounds

This sound is produced by a large empty superficial cavity communicating with a bronchus or an open
pneumothorax. Amphoric breath sounds sound like blowing air over the mouth of a large bottle. When
the pitch is relatively low and the sound hollow, it is called cavernous breathing.

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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