Breath sounds can be classified into two categories,
either NORMAL or ABNORMAL (adventitious). Breath sounds originate in
the large airways where air velocity and turbulence induce vibrations in the
airway walls. These vibrations are then transmitted through the lung
tissue and thoracic wall to the surface where they may be heard readily with the
aid of a stethescope. Normal breath sound production is directly
related to air flow velocity and airway lumen architecture. Air
flow velocity is primarily determined by pulmonary ventilation (minute
volume ®
velocity) and TOTAL cross
sectional airway area (¯
area ®
velocity) at any given level in the lungs. It is a common misconception that air moving
through terminal bronchioles (airways with a diameter <2 mm) and alveoli
also contribute to breath sounds. This is incorrect as the air
velocity at this level is too slow (very large total cross sectional area) to produce significant turbulence and
sound waves. However, terminal airway and alveolar disease does modify
the breath sounds heard at the surface by either increasing or decreasing the sound transmission
through the diseased tissue. Thus, the sounds that are heard at the
periphery of the lung are produced in more central (hilar) regions and are
altered in intensity and tonal quality as they pass through pulmonary
tissue to the periphery.
Normal Breath Sounds
Bronchial Sounds
Bronchial breath sounds consist of a
full inspiratory and expiratory phase with the inspiratory phase
usually being louder. They are normally heard over the trachea
and larynx. Bronchial sounds are not normally heard over the
thorax in resting animals. They may be heard over the hilar
region in normal animals that are breathing hard (i.e. after exercise). Otherwise, bronchial sounds heard over the thorax
suggest lung consolidation and pulmonary disease. Pulmonary
consolidation results in improved transmission of breath sounds
originating in the trachea and primary bronchi that are then heard
at increased intensity over the thorax.
Click on box to hear a bronchial breath
sound
Bronchovesicular Sounds
Bronchovesicular breath sounds consist of a full inspiratory
phase with a shortened and softer expiratory phase. They are
normally heard over the hilar region in most resting animals and
should be quieter than the tracheal breath sounds. However, in
sheep, goats, llamas, and alpacas, they may be heard throughout the
full lung field and are often louder than tracheal breath
sounds. Increased intensity of bronchovesicular sounds is most
often associated with increased ventilation or pulmonary
consolidation.
Click on box to hear a bronchovesicular breath sound
Vesicular Sounds
Vesicular breath sounds consist of a quiet, wispy inspiratory
phase followed by a short, almost silent expiratory phase.
They are heard over the periphery of the lung field. As stated
earlier, these sounds are NOT produced
by air moving through the terminal bronchioles and alveoli but
rather are the result of attenuation of breath sounds produced in
the bronchi at the hilar region of the lungs. These
sounds may be absent or silent in the periphery of normal resting
animals. They are highly variable in intensity depending on
the species, ventilation, and body condition. Increased
intensity may be associated with pulmonary consolidation.
Click on box to hear a vesicular breath sound
Abnormal Breath Sounds
Crackles
Crackles are discontinuous, explosive,
"popping" sounds that originate within the airways.
They are heard when an obstructed airway suddenly opens and the
pressures on either side of the obstruction suddenly equilibrates
resulting in transient, distinct vibrations in the airway
wall. The dynamic airway obstruction can be caused by either
accumulation of secretions within the airway lumen or by airway
collapse caused by pressure from inflammation or edema in
surrounding pulmonary tissue. Crackles can be heard during
inspiration when intrathoracic negative pressure results in opening
of the airways or on expiration when thoracic positive pressure
forces collapsed or blocked airways open. Crackles are heard
more commonly during inspiration than expiration. They are
significant as they imply either accumulation of fluid secretions or
exudate within airways or inflammation and edema in the pulmonary
tissue.
Click on box to hear a high pitched crackle
Wheezes
Wheezes are continuous musical tones that are
most commonly heard at end inspiration or early expiration.
They result as a collapsed airway lumen gradually opens during
inspiration or gradually closes during expiration. As the
airway lumen becomes smaller, the air flow velocity increases
resulting in harmonic vibration of the airway wall and thus the
musical tonal quality. Wheezes can be classified as either
high pitched or low pitched wheezes. It is often inferred that
high pitch wheezes are associated with disease of the small airways
and low pitch wheezes are associated with disease of larger
airways. However, this association has not been
confirmed. Wheezes may be monophonic (a single pitch and tonal
quality heard over an isolated area) or polyphonic (multiple pitches
and tones heard over a variable area of the lung). Wheezes are
significant as they imply decreased airway lumen diameter either due
to thickening of reactive airway walls or collapse of airways due to
pressure from surrounding pulmonary disease.
Click on box to hear a low pitch wheeze
Stridor
Stridor are intense continuous monophonic wheezes
heard loudest over extrathoracic airways. They tend to be
accentuated during inspiration when extrathoracic airways collapse
due to lower internal lumen pressure. They can often be heard
without the aid of a stethoscope. Careful auscultation with a stethoscope
can usually identify an area of maximum intensity that is associated
with the airway obstruction. This is typically either at the
larynx or at the thoracic inlet. These extrathoracic sounds
are often referred down the airways and can often be heard over the
thorax and are often mistaken as pulmonary wheezes. Stridor is
significant and indicates upper airway obstruction.
Click on box to hear stridor
Stertor
Stertor is a poorly defined and inconsistently used
term to describe harsh discontinuous crackling sounds heard over the
larynx or trachea. It is also described as a sonorous snoring
sound heard over extrathoracic airways. Stertor does not have
the musical quality of stridor. Stertor is significant as it
is suggestive of accumulation of secretions within extrathoracic
airways.