Overview
The main priorities in auscultating the lung fields during the cardiovascular examination are to assess for evidence of pulmonary oedema or a pleural effusion.
How to Perform
- Ask the patient to cross their arms over their chest and take deep breaths in and out through their mouth. Auscultate over the lung fields, alternating from left to right. Make sure to auscultate the axillae and supraclavicular fossae.
Crackles
Listen For
- Short, popping sounds. May be fine or coarse, and may be cleared by coughing (if due to secretions)
Causes of Crackles
Fine Crackles
- Pulmonary oedema - congestive cardiac failure, fluid overload
- Pneumonia
- Pulmonary interstitial fibrosis
Coarse Crackles
- Chronic bronchitis
- Bronchiectasis
- Cystic fibrosis
Wheeze
Wheeze typically suggests airway narrowing, however "cardiac wheeze" refers to a wet-sounding wheeze that occurs with pulmonary oedema.
Listen For
- High-pitched musical sounds; usually expiratory.
Causes of Wheeze
- Asthma
- Chronic obstructive pulmonary disease
- Viral bronchospasm
- Lung cancer
- Pulmonary oedema
- Aspiration
- Carcinoid syndrome
- Churg-Strauss syndrome
- Allergic bronchopulmonary aspergillosis (ABPA)
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