Thorax lungs

• Normal Breath Sounds

  • Bronchial
  • Bronchovesicular
  • Vesicular
• Bronchial


  • High pitch
  • Harsh or hollow quality
  • Loud amplitude
  • Short duration during inspiration, long in expiration
  • Located over the trachea and thorax
• Bronchovesicular


  • Moderate pitch
  • Mixed quality
  • Moderate amplitude
  • Same duration during inspiration and expiration
  • Located over the major bronchi-posterior: between the scapulae; anterior: around the upper sternum in the first and second intercostal spaces
• Vesicular


  • Low pitch
  • Breezy quality
  • Soft amplitude
  • Long in inspiration, short in expiration
  • Located in the peripheral lung fields
• Adventitious Breath Sounds


  • Crackles (fine)
  • Crackles (coarse)
  • Pleural friction rub
  • Wheeze (sibilant)
  • Wheeze (sonorous)
• Crackles (fine)


  • High-pitched, short, popping sounds heard during inspiration and not cleared with coughing
  • Sounds are discontinuous and can be simulated by rolling a strand of hair between your fingers near your ear
  • Caused by inhaled air suddenly opening the small, deflated air passages that are coated and sticky with exudate
  • Associated with restrictive diseases such as pneumonia and congestive heart failure when occurring late in inspiration, and obstructive disorders such as bronchitis, asthma, or emphysema when occurring early in inspiration
• Crackles (coarse)


  • Low-pitched, bubbling, moist sounds that may persist from early inspiration to early expiration
  • Also described as softly separating Velcro
  • Caused by inhaled air coming into contact with secretions in the large bronchi and trachea
  • May indicate pneumonia, pulmonary edema, and pulmonary fibrosis
• Pleural friction rub


  • Low-pitched, dry, grating sound
  • Sound is much like crackles, only more superficial and occurring during both inspiration and expiration
  • Caused by the rubbing of two inflamed pleural surfaces
  • Indicates pleuritis
• Wheeze (sibilant)


  • High-pitched, musical sounds heard primarily during expiration but may also be heard on inspiration
  • Caused by air passing through constricted passages (caused by swelling, secretions, or tumor)
  • Often heard in cases of acute asthma or chronic emphysema
• Wheeze (sonorous)


  • Low-pitched snoring or moaning sounds heard primarily during expiration but may be heard throughout the respiratory cycle
  • These wheezes may clear with coughing
  • Caused by the same mechanism as sibilant wheezes
  • Often heard in cases of bronchitis or single obstructions and snoring before an episode of sleep apnea
• Respiration Patterns


  • Normal
  • Tachypnea
  • Bradypnea
  • Hyperventilation
  • Kussmaul
  • Hypoventilation
  • Cheyne-Stokes respiration
  • Biot's respiration
  • Ataxic
  • Air trapping
• Normal


  • 12-20 breaths/min and regular
• Tachypnea


  • More than 24 breaths/min and shallow
  • May be a normal response to fever, anxiety, or exercise
  • Can occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy
• Bradypnea


  • Less than 10 breaths/min and regular
  • May be normal in well-conditioned athletes
  • Can occur with medication-induced depression of the respiratory center, diabetic coma, neurologic damage
• Hyperventilation


  • Increased rate and increased depth
  • Usually occurs with extreme exercise, fear, or anxiety
  • Causes include disorders of the central nervous system, an overdose of the drug salicylate, or severe anxiety
• Kussmaul


  • Rapid, deep, labored
  • A type of hyperventilation associated with diabetic ketoacidosis
• Hypoventilation


  • Decreased rate, decreased depth, irregular pattern
  • Usually associated with overdose of narcotics or anesthetics
• Cheyne-Stokes respiration


  • Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea
  • May result from severe congestive heart failure, drug overdose, increased intracranial pressure, or renal failure
  • May be noted in elderly persons during sleep, not related to any disease process
• Biot's respiration


  • Irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea
  • May be seen with meningitis or severe brain damage
• Ataxic


  • Significant disorganization with irregular and varying depths of respiration
  • A more extreme expression of Biot's respirations indicating respiratory compromise
• Air trapping


  • Increasing difficulty in getting breath out
  • In chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration