Lung and pleural auscultation

Lung and pleural auscultation is one of the most basic and important methods in lung examination, and is of great significance for the diagnosis of lung diseases. Pulmonary auscultation can take a sitting or lying position. Auscultation usually starts from the tip of the lungs, from top to bottom, from the front chest to the sides and back, and to be contrasted. During auscultation, you should take a calm breath, and if you take a deep breath or cough a few times if necessary, auscultate immediately to hear changes in breath sounds and additional sounds. Basic Information Specialist Category: Respiratory Examination Category: Other Inspections Applicable gender: whether men and women apply fasting: not fasting Tips: Poor rest before check, improper diet, excessive fatigue. Normal value Normal breathing auscultation can hear three breath sounds, including bronchial breath sounds, alveolar breath sounds, and bronchoalveolar breath sounds. Clinical significance Abnormal results: 1. Abnormal alveolar breath sounds: (1) Alveolar breath sounds weakened or disappeared: related to a decrease in gas flow into the alveoli or a decrease in airflow velocity and respiratory sound conduction disorder. Can be expressed in both lungs or one side of the lungs and local lung tissue. The reasons for this are: 1 thoracic activity is limited, such as chest pain, costal cartilage ossification and rib resection. 2 respiratory muscle diseases, such as myasthenia gravis, sputum, sputum and sputum. 3 bronchial obstruction, seen in chronic bronchitis, bronchoconstriction and so on. 4 compression lung insufficiency, found in pleural effusion or pneumothorax. 5 abdominal diseases, such as a large number of ascites, huge tumors of the abdomen. (2) Alveolar breath sound enhancement 1) Enhancement of bilateral alveolar breath sounds: The mechanism of formation is related to an increase in the flow of gas into the alveoli or an increase in the velocity of the gas entering the lungs. Reasons include: 1 exercise, fever or hypermetabolism, etc., so that the body's oxygen demand increased, at this time the breathing is deep and accelerated. 2 hypoxia excites the respiratory center, leading to increased respiratory activity, such as anemia. 3 blood acidity increased, stimulating the respiratory center, producing deep breathing, found in acidosis. 2) One side of alveolar breath sounds enhanced: seen in one side of the chest lung lesions, the side lung compensatory alveolar breath sounds enhanced. Such as thoracic deformity, pleural effusion, one side of the pneumothorax, bronchial obstruction and so on. (3) prolonged expiratory tone: seen in the lower respiratory tract, obstruction, spasm or stenosis, such as bronchial asthma. Or due to decreased elasticity of lung tissue, such as chronic obstructive emphysema. (4) Intermittent breath sounds: also known as gear breath sounds. Local inflammation or bronchoconstriction in the lungs causes air to not enter the alveoli evenly. Found in tuberculosis and pneumonia. (5) Rough breath sound: The reason is that the bronchial mucosa is mildly edematous or inflammation causes unevenness or narrowness, and the airflow is not formed smoothly. Found in the early stages of bronchial or pulmonary inflammation. 2. Abnormal bronchial breath sound: referred to as tube-like breath sounds. A bronchial breath sound is heard in the normal alveolar breath sounds, which is an abnormal bronchial breath sound. The reasons for this are: (1) Lung tissue consolidation: bronchial breath sounds are easily transmitted through the lung consolidation tissue to the body surface. The larger the range of consolidation, the more superficial, the stronger the sound. Common in the consolidation phase of lobar pneumonia. (2) Large cavity in the lung: When the large cavity in the lung communicates with the bronchus and the lung tissue around the cavity is solid, the sound resonates in the cavity, and the bronchus can be heard through the well-conducted solid tissue. Breathing sound. Common in lung abscess, hollow tuberculosis and so on. (3) Compressive atelectasis: The lung tissue is under pressure when the pleural effusion is inflated. At this time, the lung tissue is denser, which is conducive to the conduction of bronchial breath sounds, and bronchial breath sounds may appear above the effusion. 3. Abnormal bronchoalveolar breath sounds: Bronchoalveolar breath sounds are heard in the normal alveolar breath sounds, called abnormal bronchoalveolar breath sounds. Appears when the lungs are small and mixed with normal air-containing lung tissue, or when the lungs are deep and covered by lung tissue. Found in the early stage of bronchial pneumonia, tuberculosis, and lobar pneumonia, can also be heard in areas of pleural effusion above the lung swell. People who need to be examined: people with abnormal symptoms in the lungs and chest. Precautions Taboo before the examination: poor rest, improper diet, excessive fatigue. Requirements for inspection: Actively cooperate with the doctor's work. Inspection process Pulmonary auscultation can take a sitting or lying position. Auscultation usually starts from the tip of the lungs, from top to bottom, from the front chest to the sides and back, and to be contrasted. During auscultation, you should take a calm breath, and if you take a deep breath or cough a few times if necessary, auscultate immediately to hear changes in breath sounds and additional sounds. Not suitable for the crowd Inappropriate crowd: None. Adverse reactions and risks Nothing.