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Evaluation of bronchial air leaks by auscultation and phonopneumography.

Bronchial fistulae in communication with atmospheric pressure can be identified by the presence of a squeaking sound heard over the chest wall during a Valsalva maneuver. Furthermore, these leak sounds can help identify the size, location, and communications of the bronchial fistulae. The size of the leak can be inferred by the pitch of the leak sound. Large leaks produce low pitched sounds, smaller leaks (or partially obstructed leaks) produce high pitched squeaks , and multiple leaking sites produce polyphonic leak squeaks . The bronchus responsible for the leak can be identified by cessation of the leak sound during balloon occlusion of the correct bronchial stump. A communication of a bronchial fistula with the chest wall facial plane produces massive subcutaneous emphysema and an early inspiratory click. This click suggests a check valve mechanism of air exiting the leaking bronchus.

Adult↗

Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure.

Although the third heart sound (S3) is well recognized as an important sign in the evaluation of patients with congestive heart failure, the interobserver variability with its observation needs to be known before general applicability can be determined. Therefore, we determined the agreement among four trained observers on the presence of S3 in 81 hospitalized patients. Agreement between pairs of observers varied between 48 and 73 percent. The kappa statistic, which adjusts for agreement by chance alone, showed that agreement between various observer pairs was moderate (kappa = 0.40-0.50) at best and slight (kappa = 0.10-0.30) at worst. The rate of agreement did not appear to be affected by the time interval between measurements, by the sex of the patient or by a training effect over the time of the study. In conclusion, although S3 may be important as a clinical sign, clinicians cannot agree reliably about whether or not it is present.

Heart Auscultation↗

Auscultation of S3.

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Heart Auscultation↗

Auscultation of the normally functioning prosthetic valve.

Before prosthetic function can be adequately assessed, physicians must be acquainted with the normal acoustic events associated with these devices. The auscultatory findings of the most commonly used devices--ball, disk, porcine, and bileaflet valves--are reviewed. The mechanisms of sound production and their timing are discussed.

Aortic Valve↗