Chest Auscultation – respiratory 
 
Chest auscultation is the process of listening to the sounds made by the lungs, and airways, using a stethoscope. It’s a key part of a respiratory and cardiovascular examination. 
 
Purpose: 
 
To assess: 
 
Airflow through the tracheobronchial tree 
The presence of fluid, mucus, or obstruction in airways 
Abnormalities in lung tissue or pleura 
 
Equipment: 
 
Stethoscope (diaphragm for high-pitched sounds, bell for low-pitched sounds) 
Quiet environment 
Patient sitting upright (if possible) 
 
Technique: 
 
Explain the procedure to the patient. 
Position: Have the patient sit upright and breathe through the mouth, slightly deeper than normal. 
Use the diaphragm of the stethoscope. 
Systematically listen to the chest: 
Compare side to side (right vs. left) at each level. 
Listen to anterior, lateral, and posterior chest areas. 
Move from apices → bases. 
Suggested sequence: 
Anterior chest: 4–6 positions 
Posterior chest: 6–8 positions 
Lateral chest: 2–3 positions each side 
 
Normal Breath Sounds: 
 

 
Abnormal (Adventitious) Sounds: 
 

 
Special Tests: 
 
Egophony: Spoken “E” sounds like “A” → lung consolidation 
Bronchophony: Spoken “99” sounds louder → consolidation 
Whispered pectoriloquy: Whispered “1-2-3” heard clearly → consolidation 
 
Here’s how to systematically place your stethoscope during chest auscultation — for both posterior (back), anterior (front), and lateral (side) chest. 
 
Posterior Chest (Back): 
 
Best position: Patient sitting upright, arms folded across the chest. 
Stethoscope placement: 
Start above the scapulae (apices of lungs). 
Move downward and side-to-side, comparing right vs. left at each level. 
Cover at least 6–8 sites: 
2 above the scapulae 
2 between the scapulae 
2–3 below the scapulae, near the bases of lungs 
Avoid the spine and scapula directly. 
 
 Tip: Most lower lobe sounds are best heard posteriorly. 
 
Anterior Chest (Front): 
 
Best position: Patient sitting or lying down. 
Stethoscope placement: 
Begin at the supraclavicular area (above the clavicles). 
Move down to the 2nd intercostal space, midclavicular line. 
Continue downward and compare both sides at: 
4th intercostal space (right middle lobe / left upper lobe) 
6th intercostal space, near the costal margin. 
Tip: Upper lobes are best heard anteriorly. 
 
Lateral Chest (Sides) 
Best position: Patient sitting upright, arms raised above the head. 
Stethoscope placement: 
Place along the midaxillary line. 
Listen at two to three levels: 
Around 4th–6th intercostal space on the right → middle lobe 
Around 6th intercostal space on the left → lingula and lower lobes 
 
General Rules 
 
✅ Always compare right vs. left at each level. 
✅ Ask the patient to breathe through the mouth a bit deeper than usual. 
✅ Use the diaphragm for breath sounds — the bell is for low-pitched heart sounds. 
✅ Listen for one full inspiration and expiration at each site.