The auscultation is characterized by intermittent and brief, often multiple occurrences at a time, more pronounced during or at the end of inspiration, sometimes also in the early part of the whistle. The location is more constant, the nature is not easy to change, medium and small wet rales can exist at the same time, coughing can be reduced or disappear. According to the intensity of the sound of the rales can be divided into loud and non-loud two: 1.
Loud wet rales: rales are loud, due to good conduction media around, no real change, or as a result of cavity resonance, seen in pneumonia, lung abscess or cavity type tuberculosis. If the cavity wall is smooth, loud wet rales may also have a metallic tone. 2, non-sounding wet rales: the sound is lower, because there are more normal alveolar tissue around the lesion, the sound waves in the conduction gradually weakened, the sense of distant on auscultation. According to the size of the lumen diameter of the whistle tract and the amount of luminal exudate into coarse, medium and fine wet rales and twisted sounds: 1, coarse wet rales: also known as large blistering sounds, occurring in the trachea, the main bronchus or cavity site, mostly in early inspiration. It is seen in bronchiectasis, pulmonary edema, tuberculosis or lung abscess cavity. Comatose or dying patients can hear coarse wet rales, called sputum, at the trachea because of the inability to expel the inspiratory secretions. 2, medium wet rales: also known as medium vesicular sound, occurring in medium-sized bronchi, mostly in the middle of inspiration, seen in bronchitis, bronchopneumonia, etc. 3, fine wet rales: also known as small vesicular sounds, occurring in small bronchi, mostly in the late inspiration. It is commonly seen in fine bronchitis, bronchopneumonia, pulmonary stasis and pulmonary infarction, etc. In diffuse interstitial pulmonary fibrosis patients, fine wet rales appear in the late inspiratory period, with a high pitch, near the ear rather like the sound made when tearing the nylon buckle belt, called Velcro sound. 4.Twisting sound: It is a very fine and uniform wet rales. Mostly heard at the end of inhalation, rather like the sound made when twisting a bunch of hair with fingers in the ear. This is due to the presence of secretions in the bronchi and alveolar walls due to mutual adhesion trapped closed, when inspiration by the airflow to re-inflation, issued by the high-pitched, high frequency of small burst sound. It is common in fine bronchial and alveolar inflammation or congestion, such as pulmonary bruising, early pneumonia and alveolitis. However, in normal elderly or bedridden patients, twang sounds can also be heard at the base of the lungs, which can disappear after several deep whistles or coughs and are generally not clinically significant.