lung sounds: rales vs crackles vs ronchi vs coarse breath sounds

[bulldog]

What are the subtle differences between these phrases? from my understanding, crackles is replacement word for rales. i've also heard of ronchi being thrown around. and then there's coarse breath sounds.

I've used crackles for fine crackling sound like u'd get particularly at lung bases. coarse breath sounds kinda sounds kinda like a less high pitched sound--but can refer to any sound that doesn't quite sound right. anyone care to provide a more precise definition? thanks.

[superoxide]

Originally Posted by bulldog

What are the subtle differences between these phrases? from my understanding, crackles is replacement word for rales. i've also heard of ronchi being thrown around. and then there's coarse breath sounds.

I've used crackles for fine crackling sound like u'd get particularly at lung bases. coarse breath sounds kinda sounds kinda like a less high pitched sound--but can refer to any sound that doesn't quite sound right. anyone care to provide a more precise definition? thanks.

I havent had a lot of experience with breath sounds, but maybe this site with sound recordings might help:

http://www.umshp.org/rt/sounds/sounds.html

[bulldog]

Originally Posted by superoxide

I havent had a lot of experience with breath sounds, but maybe this site with sound recordings might help:

http://www.umshp.org/rt/sounds/sounds.html

thanks...i think i've seen that link before. i was particularly interested in what 'ronchi' sounds were and how they were different from crackles.

[Sushrutha]

Breathsound are divided into Vesicular breath sounds(Normal) and Adventitious breath sounds (abnormal). Adventitious breath sounds are divided in Continuos lung sound(>80 ms) and Discontinuos lung sounds(<20 ms). Continuos lung sounds consist of Wheeze and Rhonchi.
Wheeze is high pitched musical sounds especially produced in the setting of Bronchospasm ,mucosal edema or excessive secretions.
Rhonchi is lowpitched sonorous sound and may have gurgling quality.they originate in larger airways when there is excessive secretions,abnormal airway collapsibility due to repetitive rupture of surfactant film covering alveoli.
Rhonchi frequently clear after cough post tussive clearing. Always ask patient to turn aside and cough if u hear abnormal breath sounds.

Now coming to discontinuos sound those are Crackles or rales
Coarse >10 ms and fine crackles <10 ms. Fine crackles are soft and high piched sounds,crisp in nature,they are formed by explosive opening of small airways, (terminal bronchioles to alveoli) commonly seen in acute pulmonary edema and Interstial lung disease(post tussive rale they donot clear infact become more afer coughing), Coarse crepts are caused by air bubbling through fluid they are loud and low pitched sounds produced in Pneumonia,Obstructive lung disease and chronic pulmonary edema.

Hope now u can differtiate between what you want and appreciate lung sounds even better

[jdh71]

or you could just try presenting like this, "on exam the patient's lungs sound like sh!t"

[lpressley130]

Originally Posted by bulldog

thanks...i think i've seen that link before. i was particularly interested in what 'ronchi' sounds were and how they were different from crackles.

Hi BullDog:
I'm a respiratory therapist and I have been taught that rhonchi usually occurs in the larger upper airways - rhonchi can be audible (sans stethoscope) at times, depending on how bad the patient is. Rhonchi can clear with a cough or suctioning as well. Rales/crackles usually occur in the bases, unless you have a patient with fluid overload (CHF, pulm edema) - if the patient is in pulm edema due to CHF, you may have a combo going on, but at that point, discerning between rales and rhonchi is a moot point (patient needs immediate intervention). Rales sounds like fine velcro in the bases (to me...).
Visit http://www.rale.ca/Repository.htm for digital recordings of breath sounds. Hope this helps.

[dynx]

Originally Posted by bulldog

What are the subtle differences between these phrases? from my understanding, crackles is replacement word for rales. i've also heard of ronchi being thrown around. and then there's coarse breath sounds.

I've used crackles for fine crackling sound like u'd get particularly at lung bases. coarse breath sounds kinda sounds kinda like a less high pitched sound--but can refer to any sound that doesn't quite sound right. anyone care to provide a more precise definition? thanks.

The difference is how the pathology ends up looking on the chest x-ray.

[Hernandez]

Originally Posted by bulldog

I've used crackles for fine crackling sound like u'd get particularly at lung bases. coarse breath sounds kinda sounds kinda like a less high pitched sound--but can refer to any sound that doesn't quite sound right. anyone care to provide a more precise definition? thanks.

The way I use and some references distinguish between crackles and rales is a very minute distinction. I call the sound rales if it is a fine crackle in the bases very close to the end of inspiration. and I'll call them fine crackles if they're elsewhere, or coarse if they lower pitch and longer space between the sounds.

[bulldog]

Originally Posted by Sushrutha

Breathsound are divided into Vesicular breath sounds(Normal) and Adventitious breath sounds (abnormal). Adventitious breath sounds are divided in Continuos lung sound(>80 ms) and Discontinuos lung sounds(<20 ms). Continuos lung sounds consist of Wheeze and Rhonchi.
Wheeze is high pitched musical sounds especially produced in the setting of Bronchospasm ,mucosal edema or excessive secretions.
Rhonchi is lowpitched sonorous sound and may have gurgling quality.they originate in larger airways when there is excessive secretions,abnormal airway collapsibility due to repetitive rupture of surfactant film covering alveoli.
Rhonchi frequently clear after cough post tussive clearing. Always ask patient to turn aside and cough if u hear abnormal breath sounds.

Now coming to discontinuos sound those are Crackles or rales
Coarse >10 ms and fine crackles <10 ms. Fine crackles are soft and high piched sounds,crisp in nature,they are formed by explosive opening of small airways, (terminal bronchioles to alveoli) commonly seen in acute pulmonary edema and Interstial lung disease(post tussive rale they donot clear infact become more afer coughing), Coarse crepts are caused by air bubbling through fluid they are loud and low pitched sounds produced in Pneumonia,Obstructive lung disease and chronic pulmonary edema.

Hope now u can differtiate between what you want and appreciate lung sounds even better

thanks for explanation.

if i can get a consensus agreement...

crackles (aka rales) are soft discontinous high pitched fine crackling noise, particularly at lung bases. If they are lower pitched, they're called coarse sounds.

wheezing is a louder continous sound...like what u'd hear in asthmatic....may have moments when ausculatation sounds like whistling noise. if the sound is continous but lower pitched than a typical wheezing sound, u'd call it ronchi?

[Sushrutha]

Bulldog,
Thats it,what you mean is correct, Keep the basics right and it will always help you and I always say back to basics. I hope my teaching experience helped you