A. NORMAL BREATH SOUNDS (cont.

LUNG (VESICULAR) SOUNDS

MARCIAL
● Audible over peripheral lung fields
● Soft and low pitched
● Frequency range: 100-600 Hz but can still be detected with a
sensitive microphone at 1000 Hz
● Stethoscope is needed before lung sounds are appreciated
● Resembles "rustling of the leaves" as the wind blows over
trees
● Longer inspiratory phase than expiratory phase
→ I:E ratio = 3:1 or 4:1
● No pause appreciated between phases
● Inspiratory component generated primarily in the lobar and
segmental airways
● Expiratory component come from the more proximal airways
AUSCULTOGRAM
Figure 5. Lung Auscultogram of Normal Lung Sounds
(Anterior and Posterior views)
JOURNAL
● Soft and nonmusical; Heard only on inspiration and on early expiration
● Heard over the surface of the chest
→ Markedly influenced by the anatomical structures between the site
of sound generation and the site of auscultation
● Frequency range is narrower than tracheal sounds
→ Extending from below 100 Hz to 1000 Hz, with a sharp drop at
approximately 100 to 200 Hz

● Inspiratory Component: generated within lobar & segmental airways
● Expiratory Component: generated from more central sources

● If there is a decrease in sound intensity:
→ Most common abnormality
→ Can be due to the following:
▪ Decrease in the amount of sound energy at the site of generation
▪ Impaired transmission
▪ Both decrease in energy and impairment
● Sound Generation - can be decreased when there is a drop
in
inspiratory airflow which can result from several
conditions:
→ Poor cooperation (e.g. patient unwilling to take a deep breath)
→ Depression of central nervous system (e.g. drug overdose)
→ Airway conditions
▪ Blockage (e.g. by a foreign body or tumor)
▪ Narrowing in obstructive airway diseases (e.g. asthma, COPD)
− Decrease in breath sounds may be permanent as in cases of
pure emphysema or reversible, as in asthma
● Sound Transmission - can be impaired by the following:
→ Intrapulmonary Factors
▪ Harder to recognize
▪ Disruption of the mechanical properties of the lung parenchyma
(e.g. combination of hyperdistention and parenchymal
destruction in emphysema)
▪ Interposition of a medium between the source of generation and
the stethoscope that has a different acoustic impedance from
that of the normal parenchyma (e.g. pneumothorax, hemothorax
and intrapulmonary masses)
→ Extrapulmonary Factors
▪ Obesity
▪ Chest deformities (e.g. Kyphoscoliosis)
● Abdominal distention due to ascites
● Rules out clinically significant airway obstruction

BRONCHOVESICULAR SOUNDS
MARCIAL
● Best heard at the 1st and 2nd intercostal spaces anteriorly and posteriorly between the scapula
● Characteristic similar to bronchial breath sounds and normal (vesicular) lung sounds, thus explaining the name (I:E ratio = 1:1)
● Generated by turbulent flow from the large airways like the tracheal breath sounds and carries no special clinical meaning dissimilar to
tracheal sounds
AUSCULTOGRAM

Figure 6. Lung Auscultogram of Bronchovesicular Breath Sounds (Anterior and Posterior views)

MED.3.08 TBL: Lung Sounds 4 of 26