Crackles (Rales)
Crackles are discontinuous popping sounds that are heard primarily during inspiration. Contrary to popular opinion, they are not from the popping open of alveoli. In the larger airways they are thought to be caused by secretions bubbling in the airways, while in smaller airways they are thought to be caused by the popping open of the airways during inspiration. The sounds are varied, and are said to resemble the sound you hear when rubbing hair close to your ears, the crunching of leaves, or like the tearing of Velcro. Crackles may be differentiated by their quality (fine versus coarse) or by where they fall in inspiration.
Patient 1:
This is a middle-aged man with community-acquired pneumonia.
This patient also has bronchophony over the ipsilateral lung and vesicular breath sounds over the contralateral lung.
Crackles
Annotated
Patient 2:
This is a young man with community-acquired pneumonia.
Crackles
Patient 3:
This is a young man with pneumonia. Also note the presence of bronchial breath sounds.
Crackles
Crackles
Patient 4:
This is a young man with bilateral extensive pneumonia from SARS-CoV-2 infection (COVID-19).
Crackles
Annotated
Crackles
Annotated
Crackles
Annotated
Crackles
Annotated
Crackles
Annotated
Crackles
Annotated
Patient 5:
This is an older woman who developed pulmonary toxicity from a biologic agent used to treat underlying lung cancer.
This patient also has egophony.
Crackles
Annotated
Crackles
Annotated
Patient 6:
This is a young man with cystic fibrosis complicated by bronchiectasis (more severe in the left lung). Notice that the rales are coarse and mid-inspiratory.
Mid-Inspiratory Crackles
Annotated
Mid-Inspiratory Crackles
Annotated
Patient 7:
This is a middle-aged man with nonischemic cardiomyopathy who underwent left ventricular assist device placement. He has diffuse inspiratory rales thought to be secondary to amiodarone toxicity.
He also has electronic hum of the device.
Crackles
Annotated
Crackles
Annotated
Patient 8:
This is an older man who was admitted to the hospital with a diagnosis of “pneumonia” after presenting with dyspnea. Physical examination revealed elevated jugular venous pressure with Kussmaul’s sign as well as bilateral end-inspiratory rales consistent with pulmonary edema. He was subsequently diagnosed with acute coronary syndrome complicated by flash pulmonary edema.
Patient 9:
This is a middle-age woman with pneumonia caused by SARS-CoV-2 virus. There are diffuse rales (right>left).
Patient 10:
This is a young woman with chronic systolic heart failure and alcohol abuse who was admitted to the hospital with aspiration pneumonia and decompensated heart failure