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

Discussion in 'Clinical Rotations' started by bulldog, Dec 18, 2006.

  1. bulldog

    bulldog Senior Member 10+ Year Member

    Sep 8, 2002
    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.
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  3. superoxide

    superoxide Member 5+ Year Member

    Jun 29, 2006
    Munich, Germany
    I havent had a lot of experience with breath sounds, but maybe this site with sound recordings might help:
  4. bulldog

    bulldog Senior Member 10+ Year Member

    Sep 8, 2002
    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.
  5. Sushrutha

    Sushrutha Resident 10+ Year Member

    Oct 11, 2006
    :D 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
  6. jdh71

    jdh71 epiphany at nine thousand six hundred feet Physician 10+ Year Member

    Dec 14, 2006
    FEMA Camp, USA
    or you could just try presenting like this, "on exam the patient's lungs sound like sh!t"
  7. lpressley130

    lpressley130 *** Angel 5+ Year Member

    Jul 5, 2004
    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 for digital recordings of breath sounds. Hope this helps.
  8. dynx

    dynx Yankee Imperialist 10+ Year Member

    The difference is how the pathology ends up looking on the chest x-ray.
    sally23 and AnesDiva like this.
  9. Hernandez

    Hernandez Paranoid and Crotchety... Physician 10+ Year Member

    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.
  10. bulldog

    bulldog Senior Member 10+ Year Member

    Sep 8, 2002
    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 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?
  11. Sushrutha

    Sushrutha Resident 10+ Year Member

    Oct 11, 2006
    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:thumbup:

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