RHONCHUS

MARCIAL JOURNAL
● Lower in pitch <300 Hz ● Variant of the wheeze
● "Snoring" or "moaning" quality ● May be heard on inspiration, expiration, or both
● Representation in Lung Auscultogram: ● Lower pitch compared to wheeze (typically near 150 Hz)
→ Wave with sharp pointed edges ● Resembles snoring on auscultation 

▪ Thickness emphasizes louder sounds ● Share the same mechanism of generation with wheeze
▪ Pitch is approximated by the angles → Unlike the wheeze, it may disappear after coughing
AUSCULTOGRAM ▪ Suggests that secretions play a role

● Associated with rupture of fluid films and abnormal airway
collapsibility
● Often occurs with airway narrowing caused by mucous thickening
or edema or by bronchospasm (e.g. bronchitis, COPD)

Figure 8. Lung Auscultogram of a Rhonchi

STRIDOR
MARCIAL JOURNAL
● Continuous, high intensity frequency sound that may be heard ● High-pitched 

through respiration ● Produced as turbulent flow passes through a narrowed segment of the
→ Usually distinctly loud and prominent during inspiration upper respiratory tract 

● Indicates upper airway obstruction ● Often intense and clearly heard without the aid of a stethoscope 

● Very similar quality to a wheeze, but high pitched ● Sound Analysis: Regular, sinusoidal oscillations with a 
frequency of
→ Representation in Lung Auscultogram: approximately 500 Hz, often accompanied by several harmonics
▪ Smooth wave (similar to a wheeze), but with the distinct ● Difference from wheeze:
difference of pointing the arrow to the upper → More clearly heard on inspiration than on expiration
airway/trachea
▪ It is usually inspiratory, but it can also be expiratory or biphasic
AUSCULTOGRAM → More prominent over the neck than over the chest
● Can be heard due to:
→ Acute Epiglottitis 

→ Airway Edema after device removal
→ Anaphylaxis 

→ Vocal Cord Dysfunction 

▪ Often confused with asthma
▪ Also called paradoxical vocal-cord motion
− Respiratory condition characterized by inappropriate
adduction of the vocal cord with resultant airflow limitation at
the level of the larynx, accompanied by stridorous breathing
→ Inhalation of a foreign body 

→ Laryngeal tumors 

Figure 9. Lung Auscultogram of a Stridor → Thyroiditis 

→ Tracheal carcinoma 

● Clinical Correlations:
NTK: Vocal Cord Dysfunction → Indicates upper airway obstruction
● In a review of 95 patients with vocal-cord dysfunction → When heard on inspiration: associated with extrathoracic lesions
treated at the National Jewish Center, more than half (e.g. laryngomalacia, vocal cord lesion, postextubation)
carried an incorrect diagnosis of asthma for years and had
been treated with glucocorticoids. ▪ In patients who have undergone extubation, its appearance can
● Several reports have documented the costs of be a sign of extrathoracic airway obstruction
misdiagnoses vocal cord dysfunction to the medical care → When heard in expiration: associated with intrathoracic lesions
system. (e.g. tracheomalacia, bronchomalacia, extrinsic compression)
→ When biphasic: associated with fixed lesions (e.g. croup, paralysis
of both vocal cords, laryngeal mass or web)

MED.3.08 TBL: Lung Sounds 6 of 26