The sound should be hollow, representing an air-filled lung.
Use the tip of the middle finger (plexor finger) of the dominant hand to tap firmly on the top third (middle or distal phalanx) of the pleximeter finger of the non-dominant hand at least twice (it is advisable to keep fingernails short). Make sure the other fingers and palm are not pressed against the patient's chest. The firmer the finger is pressed to the chest wall, the louder the percussion note tends to be. Place non-dominant hand with middle finger (pleximeter finger) pressed and hyperextended firmly on the patient's right or left mid-back area (lower levels of lungs posteriorly). Percuss both posteriorly and anteriorly, starting on the back. Examining the posterior of the lung requires the patient to be leaning forward or sitting on the edge of the bed. Position the patient on the examination table at a 30- to 45-degree angle and approach from the right side. Make sure the patient is undressed down to the waist. RUL - right upper lobe RML - right middle lobe RLL - right lower lobe LUL - left upper lobe LLL - left lower lobe. An approximate projection of lungs and their fissures and lobes to the chest wall anteriorly. Anatomy of lungs with respect to the chest wall. The superior lobe of the left lung also has a separate projection known as the lingual.įigure 1. The left lung has two lobes: the superior and inferior lobes. The right lung has three lobes: the superior, middle, and inferior lobes. Each lung lobe can be pictured underneath the chest wall during percussion and auscultation ( Figure 1). The areas for auscultating the lungs correspond to the lung zones. Auscultation can provide an almost immediate diagnosis for a number of acute pulmonary conditions, including chronic obstructive pulmonary disease (COPD), asthma, pneumonia, and pneumothorax. Percussion is a useful skill that is often skipped during everyday clinical practice, but if performed correctly, it can help the physician to identify underlying lung pathology. Learning the proper technique for percussion and auscultation of the respiratory system is vital and comes with practice on real patients. In a normal air-filled lung, vesicular sounds are heard over most of the lung fields, bronchovesicular sounds are heard between the 1st and 2nd interspaces on the anterior chest, bronchial sounds are heard over the body of the sternum, and tracheal sounds are heard over the trachea.Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center Vesicular sounds are normally heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration. Vesicular sounds are soft, blowing, or rustling sounds normally heard throughout most of the lung fields. 
Bronchovesicular sounds are about equal during inspiration and expiration differences in pitch and intensity are often more easily detected during expiration. Bronchovesicular sounds are softer than bronchial sounds, but have a tubular quality. Bronchial sounds are loud and high in pitch with a short pause between inspiration and expiration expiratory sounds last longer than inspiratory sounds.Ĭlick here to view a brief and useful breath sounds video on YouTube presented by Bronchovesicular sounds are heard in the posterior chest between the scapulae and in the center part of the anterior chest.
These sounds are harsh and sound like air is being blown through a pipe.īronchial sounds are present over the large airways in the anterior chest near the second and third intercostal spaces these sounds are more tubular and hollow-sounding than vesicular sounds, but not as harsh as tracheal breath sounds. Tracheal breath sounds are heard over the trachea. timing (when the sound occurs in the respiratory cycle).pitch (how high or low the sound is), and.In addition to their location, breath sounds are described by: The patterns of normal breath sounds are created by the effect of body structures on air moving through airways. Normal breath sounds are classified as tracheal, bronchial, bronchovesicular, and vesicular sounds.
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