02/04/2026
Abnormal Lung Sounds (what they sound like + what they usually mean).
👉Crackles (rals) — “popping / Velcro”
• Fine crackles (high-pitched, end-inspiratory; like hair rubbing near ear)
→ Pulmonary edema/heart failure, interstitial lung disease/fibrosis, pneumonia (early), atelectasis (can clear with cough)
• Coarse crackles (lower-pitched, “bubbly”; can change after coughing)
→ Bronchiectasis, COPD with secretions, pneumonia, pulmonary edema (later)
👉Wheeze — “musical, high-pitched” (usually expiratory)
• Diffuse polyphonic wheeze
→ Asthma, COPD, bronchospasm (also allergic reaction/anaphylaxis)
• Monophonic/localized wheeze
→ Focal obstruction (mucus plug, tumor, foreign body)
• Silent chest (very little air movement despite distress)
→ Impending respiratory failure in severe asthma (emergency)
👉Rhonchi — “low-pitched snoring/gurgling”
• Often clears or changes with coughing
• → Large airway secretions: chronic bronchitis, bronchiectasis, pneumonia with mucus
👉Stridor — “harsh, loud” (usually inspiratory) heard over neck
• → Upper airway obstruction: croup, epiglottitis, foreign body, laryngeal edema
• Red flag if with drooling, tripod position, or severe distress.
👉Pleural friction rub — “leathery creak”, worse with deep breaths
• → Pleuritis (viral pleurisy), pneumonia near pleura, pulmonary embolism, TB, autoimmune pleuritis
• Usually doesn’t clear with cough.
👉Diminished/absent breath sounds
• Unilateral absent
→ Pneumothorax, large pleural effusion, mainstem intubation/obstruction
• Diffuse decreased
→ Severe COPD/emphysema, shallow breathing, obesity/hypoventilation
👉Bronchial breath sounds (abnormal if heard in peripheral lung)
• Loud, high-pitched, with a gap between inspiration and expiration
• → Consolidation (classically lobar pneumonia)
👉Voice transmission changes (helpful bedside add-ons)
• Egophony (“E” → “A”)
→ Consolidation, sometimes top of pleural effusion
• Bronchophony (spoken words sound louder/clearer)
→ Consolidation
• Whispered pectoriloquy (whispers sound clear)
→ Consolidation
• Decreased voice sounds
→ Pleural effusion or pneumothorax
Quick pattern recognition
• Wheeze = airway narrowing (asthma/COPD)
• Crackles = fluid or stiff alveoli (HF, pneumonia, fibrosis)
• Rhonchi = secretions (bronchitis)
• Stridor = upper airway obstruction (urgent)
• Absent sounds = air/ fluid outside lung or severe hyperinflation
