Author: Tarik Farrag

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Last updated on: 29.10.2020

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Rattling noises (RG, RGs) are formally considered to be breathing noises. These noises occur in addition to physiological vesicular breathing and usually indicate pathological changes. Pathophysiologically, rales are caused by the presence of secretions or fluids and the resulting altered auscultation properties of the lungs.

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Rattling noises can essentially be divided into wet and dry rattling noises. However, this classification is no longer entirely up to date. A more recent classification only refers to breathing noises and divides them into discontinuous and continuous breathing noises. However, this division into wet and dry rales is very present in clinical routine and is often used as a synonym for discontinuous and continuous breath sounds.

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Intermittent breathing noises/ Formerly moist ambient noises/rales:

Formation by thin secretions, especially during inspiration. The character of the noise indicates the section of the airways where pathological changes are present. The classification is made into fine, medium and coarse-bubble breathing sounds.

Coarse-bubble breathing noises: Lung sections with large lumen

Occurrence in: congestion of the lungs/ pulmonary oedema, bronchiectasis

Occasionally even perceptible without a stethoscope

Mid-bubble breath sounds: Lung sections with medium lumen

Occurrence with: Bronchitis

Bubbled breath sounds: Lung sections with small lumen ( in the area of the pulmonary alveoli)

Occurrence in: Pneumonia

Rattling crackles:

A special form is the crackling rattle (sclerosiphonia): Occurs in pulmonary fibrosis, can be perceived by auscultation, especially endinspiration, in the basal sections of the lung

Sound aspect of the humid breathing noises:

Sounding "close to the ear", e.g. in case of pneumonia

Not sounding "far from the ear", inside the lung, e.g. in pulmonary oedema

Metallic Pneumothorax

Continuous breathing noise/ Formerly dry ambient noise/ Rattling noises:

Formation by viscous secretions, usually accompanied by swelling of the mucous membranes. Continuous breathing noises include stridor, humming, whistling and wheezing.

Stridor both inspiratory and expiratory,

Cause: narrowing of the airways, auscultatory: audible flow noise,

Occurrence expiratory: in bronchial asthma, COPD,

Occurrence inspiratory: epiglottitis, pseudocroup, foreign body aspiration, bilateral vocal cord paresis

Hum Cause: Mucous filaments in the large airways, auscultatory: low-frequency noise, typical occurrence in asthma attacks, among others

Whistling/gumming Cause: Cause narrowing of the airways, e.g. by mucus, gumming can be explained auscultatorily by the narrowing of the smallest airways (bronchioles), typical occurrence in chronic obstructive pulmonary disease (COPD) and bronchial asthma

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Last updated on: 29.10.2020