How to differentiate

abnormal lung sound

( ronchi from rales or crackes)
RESIDENCY TIPS
Breath Sound
Breathsound are divided into
1. Vesicular breath sounds(Normal) and
2. Adventitious breath sounds (abnormal).
1. Continuos lung sound(>80 ms)  wheeze and ronchi
2. Discontinuos lung sounds(<20 ms).  Crackles or rales
Continuous abnormal breath sound

1. Wheeze
High pitched musical sounds especially produced
in the setting of Bronchospasm ,mucosal edema
or excessive secretions.
NOTES :
There is always an extending or longer period of expiration in
wheezing
 Continuous abnormal breath sound
2. Rhonchi
Low pitched sonorous sound and may have
gurgling quality.they originate in larger airways
when there is excessive secretions, abnormal airway collapsibility due to
repetitive rupture of surfactant film covering alveoli.
NOTES :
a) Rhonchi frequently clear after cough post tussive clearing. Always
ask patient to turn aside and cough if u hear abnormal breath
sounds.
b) Can be detected by placing stethoscope in upper part of thorax, or
listened without stethoscope. In Indonesia, sometimes it was called
as slym
 Discontinuous abnormal breath sound

1. Coarse (>10 ms)

◦ Coarse crepts are caused by air bubbling through fluid
◦ They are loud and low pitched sounds produced in
Pneumonia, Obstructive lung disease and chronic pulmonary
edema.
 Discontinuous abnormal breath sound

2. fine crackles (<10 ms).

◦ Fine crackles are soft and high piched sounds,crisp in nature,they are
formed by explosive opening of small airways, (terminal bronchioles
to alveoli)
◦ Commonly seen in acute pulmonary edema and Interstial lung
disease
NOTES
◦ The easiest way to differentiate crackles from ronchi is post tussive
rale they do not clear infact become more afer coughing),