[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) › Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rub [Clinical exam](https://durgical.com/en/clinical-exam/) · [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) # Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rub - Sign Sounds that do not exist in healthy lungs; each type points to a different mechanism: fluid, narrow airways or inflamed pleura. Updated 2026-11-01 **See it in 3D:** [Pleura](https://durgical.com/en/anatomy/pleura/) · [Trachea](https://durgical.com/en/anatomy/trachea/) · [Segmental bronchi](https://durgical.com/en/anatomy/segmental-bronchus/) ## Key points - Fine late-inspiratory crackles: interstitial fibrosis, heart failure, evolving pneumonia. - Coarse early-inspiratory crackles that change with coughing: secretions in the bronchi (bronchitis, bronchiectasis). - Wheezes: continuous, musical, mostly expiratory; narrowed airways (asthma, COPD). A fixed, localized wheeze suggests a tumour or foreign body. - Stridor: inspiratory, high-pitched, loudest over the neck; obstruction of the larynx or trachea, an emergency. - Pleural rub: harsh, in both phases, localized, unchanged by coughing and gone when breathing stops. - Rhonchi: continuous, low-pitched, from secretions in large airways; they often change with coughing. ## What it is Adventitious (added) sounds are heard on top of normal breath sounds. They are discontinuous (crackles) or continuous (wheezes, rhonchi and stridor); the pleural rub arises from the pleura. Recognizing them, placing them in the breathing cycle and checking whether they change with coughing guides the diagnosis. ## The anatomy it tests - Crackles come from sudden opening of collapsed small airways or alveoli, or from air bubbling through secretions. - Wheezes come from vibration of narrowed bronchial walls, nearly touching, with fast airflow between them. - Stridor reflects narrowing of the upper extrathoracic airway (larynx, subglottis, cervical trachea), which collapses more on inspiration. - A rub arises when inflamed, roughened visceral and parietal pleura slide over each other. ## How to elicit it - Listen with the diaphragm at symmetric points while the patient breathes through the mouth a little deeper than usual. - For any added sound, decide whether it is continuous (musical) or discontinuous (like bubbles or Velcro). - Place it in time: early or late inspiration, expiration or both phases. - Ask the patient to cough and listen again: sounds from secretions change or clear. - If a rub is suspected, ask the patient to hold the breath: a pleural rub stops; a pericardial rub continues. - If you hear a high-pitched inspiratory sound, listen over the neck: stridor is loudest over the larynx and trachea. - Record type, site, phase and change with coughing. ## What a positive result means - Persistent fine bibasal crackles: interstitial lung disease or cardiogenic pulmonary edema. - Localized crackles with bronchial breathing and fever: pneumonia. - Diffuse expiratory wheezes: asthma or COPD; in infants, also bronchiolitis. - Stridor with fever and a barking cough in a child: croup; sudden stridor while eating or playing: foreign body. - Pleural rub with pain on breathing: pleuritis (pneumonia, pulmonary embolism, autoimmune disease); it may fade as fluid builds up. - No added sounds does not rule out disease: early or deep pneumonia may sound normal. ## Usefulness and limits - Agreement between examiners is moderate for crackles and wheezes, and poor for less standard terms such as rhonchi. - Basal crackles that clear after several deep breaths may be atelectasis in people who have been lying down. - Chest radiograph, lung ultrasound and spirometry confirm what auscultation suggests. ## Memory aid Continuous sings (wheeze, rhonchus, stridor); discontinuous crackles; the pleura scrapes (rub). ## Test yourself Think of the answer, then tap the question to see it. ## Which added sound suggests pulmonary fibrosis? Fine, Velcro-like, late-inspiratory crackles, mainly at both bases. ## How is a pleural rub told from a pericardial rub at the bedside? Ask the patient to hold the breath: a pleural rub stops, a pericardial rub continues because it follows the heartbeat. ## What does stridor mean and where is it loudest? Upper airway obstruction (larynx or trachea); it is loudest over the neck and mainly inspiratory. It is an emergency. ## What does a single, fixed, localized wheeze suggest? Focal obstruction of one bronchus, for example by a tumour or a foreign body. ## Which sounds change with coughing? Those from secretions: coarse crackles and rhonchi. Fine crackles and a pleural rub do not change with coughing. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Pleura](https://durgical.com/en/anatomy/pleura/) - [Trachea](https://durgical.com/en/anatomy/trachea/) - [Segmental bronchi](https://durgical.com/en/anatomy/segmental-bronchus/) ## Related - [Lung auscultation: normal breath sounds](https://durgical.com/en/clinical-exam/lung-auscultation-normal-breath-sounds/) - [Bronchial obstruction syndrome](https://durgical.com/en/clinical-exam/bronchial-obstruction-syndrome/) - [Consolidation syndrome](https://durgical.com/en/clinical-exam/consolidation-syndrome/) - [Heart failure syndrome: left- and right-sided signs](https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) ## Related conditions - [Asthma](https://durgical.com/en/conditions/asthma/) - [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/) - [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Interstitial lung disease](https://durgical.com/en/conditions/interstitial-lung-disease/) - [Bronchiectasis](https://durgical.com/en/conditions/bronchiectasis/) - [Croup (laryngotracheobronchitis)](https://durgical.com/en/conditions/croup/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Breath sounds: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007535.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Asthma: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000141.htm) (MedlinePlus, U.S. National Library of Medicine, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/