Adventitious Breath Sounds
October 27th, 2020
Overview
Adventitious sounds are abnormal sounds heard on the chest in inspiration or expiration, in addition to the normal breath sounds.
Stridor
Stridor refers to musical, high-pitched sounds heard in the upper airways on auscultation. Stridor may even be audible without a stethoscope.
Stridor is a sign of upper airway obstruction.
Causes of Stridor
- Soft tissue swelling - peritonsillar abscess, epiglottitis, burns
- Deformity - laryngomalacia, laryngeal mass / web, tracheomalacia
- Foreign body aspiration
- Laryngotracheobronchitis (croup)
- Tongue enlargement / displacement
- Vocal cord lesion / paralysis
- Psychogenic stridor
Wheeze
Wheeze is the presence of high-pitched musical sounds on auscultation of the chest, which may be heard on inspiration or expiration.
Wheeze is a sign of airway narrowing.
Causes of Wheeze
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Viral bronchospasm
- Bronchiectasis
- Pulmonary oedema
- Aspiration
- Bronchial / tracheal obstruction - foreign body, tumour, stenosis
- Churg-Strauss syndrome
- Carcinoid syndrome
- Allergic bronchopulmonary aspergillosis (ABPA)
Crackles / Crepitations
Crackles or crepitations are short, explosive sounds heard on auscultation of the chest. They may be fine or coarse in character, and may be cleared by coughing (if due to secretions).
Causes of Crackles / Crepitations
Coarse Crepitations
- Pneumonia
- Bronchiectasis
- Chronic bronchitis
- Pulmonary oedema - congestive cardiac failure, fluid overload
Fine Crepitations
- Interstitial lung fibrosis
Pleural Rub
A pleural rub is a classical sign of pleural inflammation, also known as pleurisy.
Listen For
- Non-musical, explosive sounds best heard at the lung bases.
Causes of Pleurisy
- Infection - viral, bacterial, tuberculosis, fungal
- Malignancy - lung cancer, mesothelioma, lymphoma
- Autoimmune - rheumatoid arthritis, SLE
- Pulmonary embolism
- Familial Mediterranean fever
- Asbestosis
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