Lena Torres
Lung sounds, or breath sounds, are the noises generated by the movement of air through the respiratory system. They can be easily audible or identified through auscultation with a stethoscope. Normal breath sounds are classified as vesicular, bronchovesicular, bronchial, or tracheal, depending on the anatomical location of auscultation. However, certain pathological conditions can lead to abnormal lung sounds, such as rhonchi, wheezing, stridor, crackles (rales), and pleural rub. Crackles or rales are described as discontinuous, interrupted, or explosive sounds that might sound like rattling, bubbling, or clicking. While fine crackles are short and high-pitched, coarse crackles have a lower pitch and last longer. Coarse crackles, also known as moist crackles, are indicative of specific lung conditions and are often associated with inflammation or infection. This classification aims to differentiate them from fine crackles, which are shorter and higher-pitched.
| Characteristics | Values |
|---|---|
| Description | Moist sounds are described as discontinuous, interrupted, or explosive. They might sound like rattling, bubbling, or clicking. |
| Also Known As | Crackles, rales, alveolar rales, pleural friction rub, pleural rub |
| Cause | Air passing through fluid, pus, or mucus |
| Heard During | Inhalation, and occasionally during exhalation |
| Indicates | Interstitial process, such as pulmonary fibrosis or congestive heart failure |
| Pitch | Low |
| Duration | Longer than fine crackles |
| Volume | Louder than fine crackles |
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What You'll Learn
- Moist crackles, or coarse crackles, are lower-pitched and moist-sounding
- Rales are discontinuous, interrupted, or explosive sounds
- Fine crackles are short, high-pitched sounds
- Pleural rub is a rough, grating sound of the lung membranes rubbing against each other
- Rhonchi are continuous, low-pitched sounds that sound like snoring or gurgling
Moist crackles, or coarse crackles, are lower-pitched and moist-sounding
Lung sounds, or breath sounds, are the noises generated by the movement of air through the respiratory system. These may be easily audible or identified through auscultation of the respiratory system with a stethoscope.
Breath sounds include normal breath sounds and added sounds. Normal breath sounds are classified as vesicular, bronchovesicular, bronchial, or tracheal based on the anatomical location of auscultation. Vesicular lung sounds usually mean nothing is blocking the airways, and they are fully open.
Added sounds, also known as adventitious breath sounds, include crackles (formerly called rales), wheezes, pleural friction rubs, stertor, and stridor. Crackles are discontinuous, interrupted, or explosive sounds that might sound like rattling, bubbling, or clicking. They are caused by the "'popping open'" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. Crackles can be further categorized as coarse or fine. Fine crackles, or "crepitation," are short, high-pitched sounds.
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Rales are discontinuous, interrupted, or explosive sounds
Rales, also known as crackles, are discontinuous, interrupted, or explosive sounds. They are abnormal lung sounds that may indicate a blockage in the airway. Rales can be described as having a rattling, bubbling, or clicking sound quality. They are believed to occur when air opens closed air spaces.
Rales are often associated with conditions such as pneumonia, congestive heart failure, or interstitial lung disease. Pneumonia causes lung tissues to swell and can lead to fluid or pus accumulation in the airways. Congestive heart failure results in blood building up in the lungs and other parts of the body due to inefficient blood circulation. Interstitial lung disease, on the other hand, is a group of inflammatory lung conditions characterised by scarring in the lungs.
The presence of rales can be a significant indicator of underlying health issues. For instance, if a baby exhibits rales, it may suggest pneumonia or a blockage in their airway. Additionally, rales can be further characterised as moist or dry. This distinction provides additional context for healthcare providers when evaluating lung health.
Healthcare providers often use a stethoscope to listen to lung sounds and evaluate the respiratory system. The description and classification of these sounds involve auscultation, where the inspiratory and expiratory phases of the breath cycle are observed. During auscultation, the pitch and intensity of the sounds are also noted. Rales are typically heard when a person inhales, and they are more likely to be detected by a healthcare provider during inhalation as well.
In summary, rales, or crackles, are discontinuous, interrupted, or explosive sounds that can be indicative of various lung conditions. They are often heard during inhalation and can be further characterised as moist or dry. Healthcare providers use auscultation techniques to identify and classify these abnormal lung sounds.
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Fine crackles are short, high-pitched sounds
Crackles, also called rales, are discontinuous, interrupted, or explosive sounds. They might sound like rattling, bubbling, or clicking. Fine crackles, or "crepitation", are short, high-pitched sounds. They are soft and very brief. Fine crackles can be simulated by rolling a strand of hair between one's fingers near the ears or by moistening one's thumb and index finger and separating them near the ears. Fine crackles are indicative of an interstitial process, such as pulmonary fibrosis or congestive heart failure.
Fine crackles are often described as sounding like the opening of a Velcro fastener. They are indicative of an interstitial process and are commonly heard in the bases of the lung lobes during inhalation. Fine crackles are also associated with pulmonary fibrosis and congestive heart failure. The sound quality of fine crackles is similar to the sound of hair being rubbed between your fingers near your ear.
Coarse crackles, on the other hand, are louder, lower in pitch, and last longer than fine crackles. They are indicative of airway disease, such as bronchiectasis. Coarse crackles are also associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that do not clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure, pulmonary fibrosis, or acute respiratory distress syndrome.
Rhonchi, or continuous low-pitched sounds, are another type of abnormal lung sound. They are best heard when breathing out and may move around to different parts of the chest when coughing, moving mucus around. They are sometimes described as snoring or gurgling and are caused by blockages in the main airways by mucous secretions, lesions, or foreign bodies.
Wheeze is another abnormal lung sound characterised by a continuous, high-pitched hissing sound. Sibilant wheezes are higher-pitched, shrill, and continuous whistling sounds that occur when the airway becomes obstructed and narrowed. They are commonly heard in patients with asthma, chronic bronchitis, or chronic obstructive pulmonary disease (COPD).
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Pleural rub is a rough, grating sound of the lung membranes rubbing against each other
Pleural rub, or pleural friction rub, is an abnormal lung sound characterised by its rough, grating quality. It is caused by the visceral and parietal pleura, or the lung membranes, rubbing against each other. Typically, these membranes slide smoothly over one another, lubricated by a small amount of serous fluid. However, when this fluid is disrupted or the membranes become inflamed, roughened, or thickened, the motion of the membranes becomes obstructed, producing a grating sound.
Pleural rub can be identified by listening to the internal sounds of the body with a stethoscope. It is audible during both inspiration and expiration, and its distinctive sound has been likened to treading on fresh snow, the creaking of leather, or the sound of a stringed instrument. Pleural rub may be difficult to distinguish from other abnormal lung sounds, such as crepitations, which can be altered by coughing.
Pleural rub is often associated with conditions affecting the chest cavity, such as pleurisy, pneumonia, pulmonary embolism, and pulmonary edema. It can be a symptom of a serious lung condition and may indicate the presence of inflammation or infection in the pleura. Pleural rub can also occur due to chest injuries, such as broken ribs or trauma from car collisions or assaults.
The prognosis of pleural rub depends on its underlying cause. For example, in cases of malignancy-related pleural effusion, the prognosis is often guarded, with a high mortality rate. Identifying the presence of pleural rub and its underlying cause is crucial for clinicians to diagnose and treat patients presenting with respiratory complaints.
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Rhonchi are continuous, low-pitched sounds that sound like snoring or gurgling
Rhonchi are continuous, low-pitched sounds that resemble snoring or gurgling. They are caused by a blockage in the upper airway, specifically in the larger airways of the lungs, known as bronchi and bronchioles. This blockage can be caused by fluid, mucus, or other secretions. When air passes through these obstructions, it creates a snoring or gurgling sound.
Rhonchi are best heard when a person is breathing out, also known as expiration. However, they may also be heard when breathing in and out. The sound may move to different parts of the chest when coughing, as mucus is moved around. This sound is sometimes called "sonorous rhonchus".
Rhonchi are often associated with obstructive lung diseases, where damage to the airways slows down the exhalation process. Examples of such diseases include chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma, cystic fibrosis, and pneumonia.
Rhonchi are considered abnormal or adventitious lung sounds. They are one of the five most common adventitious lung sounds, along with wheezing, rales, stridor, and pleural rub. These abnormal sounds can be caused by congestion in the lungs, which is usually due to mucus or swelling.
Healthcare providers listen for lung sounds using a stethoscope placed on the chest or back. While normal lung sounds are smooth and soft, indicating clear airways, rhonchi indicate a blockage or narrowing of the airways. This can be caused by mucus, swelling, or inflammation.
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Frequently asked questions
Moist lung sounds are adventitious or abnormal breath sounds that can be described as coarse or fine crackles. They are discontinuous, interrupted, or explosive sounds that may be caused by air passing through fluid, pus, or mucus.
Rales, also known as crackles, are discontinuous, interrupted, or explosive lung sounds. They are believed to occur when air opens closed air spaces. Rales can be moist or dry and are often described as clicking, bubbling, rattling, or crackling.
Coarse lung sounds are deeper and lower-pitched than fine crackles and are often described as moist or wet. They are caused by the “popping open” of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during exhalation.
Moist sounds can be either rales or coarse. Moist rales are a type of moist lung sound, while coarse crackles are a type of moist crackle. Therefore, moist sounds can be classified as either rales or coarse depending on the specific context and underlying pathology.
