Physical examination maneuver

Physical Exam

Lung Auscultation

🎬
Video coming September 2026

How to Perform

Using the diaphragm of the stethoscope, listen over symmetric points on the anterior, lateral, and posterior chest while the patient breathes slowly and deeply through an open mouth. Compare side to side at each level, noting the intensity and quality of the breath sounds and any added sounds (crackles, wheezes, rhonchi, or a pleural rub).

How to Interpret

Showing 11 of 30 findings

Chronic Obstructive Pulmonary Disease

Expiratory wheezing on auscultation in an adult with respiratory symptoms
Rule in
Somewhat helpful
Rule out
—
Evidence:Strong

COPD with Hyperinflation

Diminished or absent breath sounds on auscultation in an adult with respiratory symptoms
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Strong

Heart Failure

Fine inspiratory crackles (rales) on auscultation
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Strong
Wheezing on auscultation in an adult presenting with dyspnea to the emergency department
Rule in
—
Rule out
Minimally helpful
Evidence:Strong

Lobar Pneumonia or Consolidation

Bronchial breath sounds in peripheral lung
Rule in
Somewhat helpful
Rule out
—
Evidence:Moderate

Mainstem Bronchus Intubation

Asymmetric breath sounds
Rule in
Helpful
Rule out
Somewhat helpful
Evidence:Limited

Pleural Effusion

Diminished breath sounds
Rule in
Helpful
Rule out
Very helpful
Evidence:Limited

Pneumonia

Crackles (any type — fine, coarse, or unspecified) on lung auscultation
Rule in
Somewhat helpful
Rule out
—
Evidence:Strong
Rhonchi
Rule in
Minimally helpful
Rule out
—
Evidence:Strong
Pleural friction rub
Rule in
Not helpful
Rule out
Not helpful
Evidence:Strong

Pneumothorax

Diminished breath sounds
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Strong

References

  • Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. doi:10.1001/jama.294.15.1944. PMID: 16234501. JAMA Rational Clinical Examination systematic review of 22 studies of adult ED patients with dyspnea. PubMed abstract freely accessible; specific per-finding values widely tabulated in secondary literature. Verified via DARE NBK71447 (NCBI Bookshelf, Centre for Reviews and Dissemination quality-assessed entry, open access) during BedsideDx Scope B audit cascade #38 (2026-05-14): DARE summary reproduces Wang 2005 per-feature pooled LR values exactly. CRD commentary: methods 'appropriate'; conclusions 'likely to be reliable'; two CRD-noted limitations are (i) MEDLINE-only English-only search may have missed relevant studies and (ii) heterogeneity not formally assessed. Neither limitation challenges the headline per-feature pooled LRs.
  • Manfredi A, et al. Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study. BMC Pulm Med. 2019;19:111. PMID: 31221137.
  • Moran-Mendoza O, Ritchie T, Aldhaheri S. Fine crackles on chest auscultation in the early diagnosis of idiopathic pulmonary fibrosis: a prospective cohort study. BMJ Open Respir Res. 2021;8(1):e000815. PMID 34233892. DOI 10.1136/bmjresp-2020-000815.
  • Ebell MH, Chupp H, Cai X, Bentivegna M, Kearney M. Accuracy of Signs and Symptoms for the Diagnosis of Community-acquired Pneumonia: A Meta-analysis. Acad Emerg Med. 2020;27(7):541-553. PMID: 32329557.
  • Htun TP, Sun Y, Chua HL, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Sci Rep. 2019;9(1):7600. doi:10.1038/s41598-019-44145-y. PMID: 31110214. PMC: PMC6527561. Open access. PRISMA-compliant systematic review with QUADAS-2 quality assessment. 13 included studies (n=11,144 total adult participants in primary care, outpatient, and emergency department settings). Pooled at the categorical 'crackles present' level per Htun's Table 2 random-effects bivariate model. Reference standard for pneumonia: chest radiograph in 13 studies. [2026-06-04 audit, Entry #347: PMID corrected 31110214->31110214; crackles pooled LR+ 2.42 (95% CI 1.19-4.69) abstract-verified across 7 studies; per-finding sensitivity/specificity are in the full-text Table 2 (open-access PMC6527561), were not abstract-verifiable, and are not carried in the displayed stats.]
  • Arts L, Lim EHT, van de Ven PM, Heunks L, Tuinman PR. The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis. Sci Rep. 2020;10:7347. PMID: 32355210. doi:10.1038/s41598-020-64405-6.
  • Kalantri S, et al. Respir Med. 2007. PMID: 17368889.
  • Arts L, et al. Sci Rep. 2020. PMID: 32355210.
  • Sitzwohl C, Langheinrich A, Schober A, Krafft P, Sessler DI, Herkner H, Gonano C, Weinstabl C, Kettner SC. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial. BMJ. 2010;341:c5943. PMID: 21062875. doi:10.1136/bmj.c5943.
  • Heckerling PS, Tape TG, Wigton RS, Hissong KK, Leikin JB, Ornato JP, Cameron JL, Racht EM. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med. 1990;113(9):664-670. doi:10.7326/0003-4819-113-9-664. PMID: 2221647. Single-center prospective prevalence cohort study (derivation cohort: n=1,134 adult ED patients at University of Illinois Hospital at Chicago presenting with fever or respiratory complaints and receiving a chest radiograph as the reference standard; validation cohort: n=302 across two additional ED sites). Table 6 of the original Heckerling 1990 paper reports prevalence of bronchial breath sounds at 14.4% in pneumonia-positive patients vs 4.3% in non-pneumonia patients, giving univariate sensitivity 0.14, specificity 0.96, LR+ 3.5. Tabulated in Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278(17):1440-1445 (the 'Rational Clinical Examination' series), which uses Heckerling 1990 as the primary evidence for bronchial breath sounds in pneumonia. Note: bronchial breath sounds is NOT one of the 5 components of Heckerling's prediction rule -- the 5 rule components are temperature > 37.8 deg C, heart rate > 100, crackles (rales), decreased breath sounds, and absence of asthma. Bronchial breath sounds was an individual sign reported in Heckerling Table 6 but did not survive into the multivariable rule.
  • Laënnec RTH. De l'auscultation médiate ou traité du diagnostic des maladies des poumons et du cœur. Paris: Brosson et Chaudé; 1819.

Related Chief Complaints

Abdominal DistensionAbdominal PainAnkle SwellingBarking CoughChest DiscomfortChest PainChest TightnessChest TraumaChillsChokingChronic CoughCoughCough in a ChildCough Productive of SputumCoughing Up BloodDecreased Breath SoundsDifficulty SwallowingDifficulty VentilatingDroolingDry CoughEarly SatietyExercise IntoleranceExertional DyspneaFacial SwellingFatigueFeverHivesHoarse VoiceIncreased SputumItchingLeg SwellingLightheadednessLoss of AppetiteLow Blood PressureLow Oxygen LevelsMuffled VoiceNeck PainNeck SwellingNoisy BreathingOrthopneaPain Worse with BreathingPalpitationsParoxysmal Nocturnal DyspneaPink Frothy SputumPleuritic Chest PainRapid BreathingRashRecurrent PneumoniaRecurrent Respiratory InfectionsRib PainSharp Chest PainShortness of BreathSore ThroatStridorSudden Chest PainSudden CoughSwelling of the LipsSyncopeThroat TightnessVoice ChangeVomitingWeight GainWeight LossWheezingWorsening Cough

Related Systems / Regions

RespiratoryThorax

Related Bedside Tests

🎬Video coming Sept 2026
Oxygen Saturation
aka Pulse oximetry
Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more
Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more
🎬Video coming Sept 2026
Chest Percussion
Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more
Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more
🎬Video coming Sept 2026
Respiratory Rate
Rule in:SHPneumonia, IEHeart Failure, IEIncreased Intracranial Pressure +3 more
Rule out:MHPulmonary Embolism, IEHeart Failure, IEIncreased Intracranial Pressure +3 more
🔒Sign in
Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more
🎬Video coming Sept 2026
Heart Rate
Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more
Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more
🎬Video coming Sept 2026
Jugular Venous Pressure
Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more
Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more