Lung Sounds Differential Diagnosis

Lung Sounds: Differential Diagnosis

Rales (Crackles)
■ Simulated by rolling hair near ear between two fingers.
■ Best heard on inspiration in lower bases.
■ Unrelieved by coughing.
■ Associated with bronchitis, CHF, and pneumonia.

Wheezes
■ High-pitched, squeaky sound.
■ Best heard on expiration over all lung fields.
■ Unrelieved by coughing.
■ Associated with asthma, bronchitis, CHF, and emphysema.

Rhonchi
■ Coarse, harsh, loud gurgling.
■ Best heard on expiration over bronchi and trachea.
■ Often relieved by coughing.
■ Associated with bronchitis and pneumonia.

Stridor
■ Harsh, high-pitched, audible sound.
■ Easily heard without stethoscope during inspiration and expiration.
■ Indicates progressive narrowing of upper airway and can be lifethreatening, requiring immediate attention.
■ Associated with partial airway obstruction, croup (inspiratory), and epiglottitis (severe, audible).

Unilaterally Absent or Diminished
■ Inability to hear equal, bilateral breath sounds.
■ Associated with pneumothorax, tension pneumothorax, hemothorax, or history of pneumectomy.

Documentation of Lung Sounds
■ Rate, rhythm, depth, effort, sounds (indicate if sound is inspiratory and/or expiratory phase), and fields of auscultation.
■ Interventions (if any implemented) and outcomes.