AuscultifyLung Auscultation Sites: Anterior, Posterior and Lateral Landmarks
Listen to the lungs in a ladder pattern, alternating left and right at each level so every site is compared with its mirror image. Cover three groups: posterior (typically 8 to 10 sites, from above the scapulae, down between the scapulae at T3 to T7, to the bases at about T10, never on the scapula itself), anterior (4 to 6 sites from the supraclavicular area to about the 6th rib) and lateral (the axillary lines around the 4th to 6th intercostal spaces, which are the only reliable sites for the right middle lobe and lingula).
The heart and lung sites hub gives the overview; this page goes site by site, with the lobe each one samples and the technique and pediatric details that decide whether you actually hear anything.
Surface anatomy: which lobe is under each site
The lobes are not stacked top to bottom. The oblique fissure runs from about T3 posteriorly down and forward to the 6th rib anteriorly, so the upper lobes are mostly anterior and the lower lobes are mostly posterior. On the right, the horizontal fissure at the 4th rib separates the right middle lobe, which faces forward and to the side and has almost no posterior surface. The lingula of the left upper lobe occupies the equivalent anterior and lateral position on the left. Three consequences follow:
- Posterior auscultation below about T3 is almost entirely lower lobe. Basal crackles and effusions are found here.
- Anterior auscultation above the 4th rib is upper lobe. Apical disease such as tuberculosis is found here and above the clavicles.
- The right middle lobe and lingula are only heard from the front and lateral chest. A posterior-only exam misses them completely.
Posterior sites
Sit the patient upright with arms folded across the chest to pull the scapulae apart, or ask them to hug a pillow. Work down in pairs:
| Site (paired, left and right) | Landmark | Lobe sampled |
|---|---|---|
| Apices | Above each scapula, C7 to T1 level | Upper lobe apex |
| Upper interscapular | Paravertebral line at about T3, medial to the scapula | Upper lobe (upper edge of lower lobe) |
| Mid interscapular | Paravertebral line at about T5 to T6 | Lower lobe |
| Lower interscapular | Paravertebral line at about T7, scapular tip level | Lower lobe |
| Bases | About T9 to T10, below the scapular tip | Lower lobe base |
| Posterolateral bases | Posterior axillary line, T8 to T10 | Lower lobe, lateral segment |
Six paired positions give 12 listens; drop the posterolateral pair if time is tight and you get the common 10-site posterior exam. Stay medial to the scapula on the upper sites; bone under the diaphragm blocks sound.
Anterior sites
| Site (paired) | Landmark | Lobe sampled |
|---|---|---|
| Supraclavicular | Just above the medial clavicle | Upper lobe apex |
| Infraclavicular | 2nd intercostal space, midclavicular line | Upper lobe |
| Mid anterior | 4th intercostal space, midclavicular line | Right: middle lobe; left: upper lobe and lingula |
| Lower anterior | 6th intercostal space, anterior axillary line | Right: middle lobe; left: lingula and lower lobe edge |
On the left, the heart occupies the medial lower chest, so move laterally rather than trying to listen through it.
Lateral sites
Raise the patient's arm and listen in the midaxillary line at roughly the 4th and 6th intercostal spaces, with a third site at the 8th space if you want the lateral base. On the right the 4th to 6th spaces overlie the right middle lobe; on the left the same spaces overlie the lingula, with lower lobe below. These two or three paired sites are the ones most often skipped, and they are the ones that catch right middle lobe pneumonia.
Technique that decides whether you hear anything
- Diaphragm, on skin. Breath sounds are high frequency. Listening through a gown produces scratching that mimics crackles and muffles the real sounds. See the bell vs diaphragm guide.
- Mouth open, slightly deeper than normal breathing. Nasal breathing adds upper airway noise.
- One full breath per site. Inspiration and expiration carry different findings: fine crackles are late inspiratory, wheeze is usually expiratory.
- Compare symmetrically. Move left, right, then down. Asymmetry is the most reliable abnormal finding, and it is invisible if you do one whole side first.
- Watch for hyperventilation. Twenty deep breaths in a row makes patients light-headed. Pause every few sites, or listen to normal-depth breaths once you have covered the bases.
Normal sounds by location
Where you are on the chest determines what normal sounds like. Over the trachea and larynx you hear bronchial (tracheal) breathing: loud, hollow, high pitched, with expiration as long as or longer than inspiration and a pause between them. Over the manubrium anteriorly and between the scapulae posteriorly, where the main bronchi lie, you hear bronchovesicular sounds with roughly equal inspiratory and expiratory phases. Everywhere else in the periphery you should hear vesicular breathing: soft, low pitched, inspiration longer than expiration, no pause. Bronchial breathing in a peripheral site means consolidation.
Pediatric lung auscultation points
The sites are the same, but the execution changes. Use a pediatric or infant chest piece so the diaphragm fits within one intercostal space; an adult diaphragm on a toddler samples half the chest. Listen during quiet breathing, or in the pauses between cries, and make use of the deep breath a child takes after crying. A small, thin chest transmits sounds widely, including upper airway noise from the nose and throat, so a wheeze or crackle heard at one site may originate elsewhere. Localize by finding where the sound is loudest, by checking the lateral sites and bases where transmitted upper airway noise is weakest, and by listening over the nose or mouth to see if the noise matches.
Common errors
- Listening through clothing or over the scapulae.
- Skipping the lateral sites, and with them the right middle lobe and lingula.
- Doing the whole left side then the whole right side instead of alternating.
- Moving on after half a breath, missing late inspiratory crackles.
- Listening only posteriorly on a supine patient and calling the exam complete.
- Confusing tubing noise, chest hair and shivering with crackles or rubs.
Practice lung sounds by site in Auscultify
Auscultify's library includes real clinical lung recordings tagged with the site they were captured at, so you learn what vesicular breathing sounds like at a base and what crackles sound like at the same spot. The Lung Sounds quiz mode plays them without labels, difficulty levels start you on obvious findings and work up to subtle ones, and missed sounds are weighted to come back sooner.
Train lung sounds free →FAQ
Where do you place the stethoscope for lung sounds?
On bare skin, in a ladder pattern that alternates left and right at each level. Posteriorly, start above the scapulae, move down between the scapulae and on to the bases at roughly T10. Anteriorly, start just below the clavicles and work down to about the 6th rib. Laterally, listen in the axillary line around the 4th to 6th intercostal spaces.
What are the lung auscultation sites?
Three groups: posterior sites from the apices above the scapulae down the paravertebral lines to the bases, anterior sites from the supraclavicular and infraclavicular areas down to the 6th rib, and lateral sites in the axillary lines. Together they sample every lobe, including the right middle lobe and lingula.
How many lung auscultation sites are there?
Most guides teach 8 to 10 posterior sites, 4 to 6 anterior sites and 2 to 4 lateral sites, around 14 to 20 paired positions in total. The exact number matters less than covering every lobe and comparing each site with its mirror image.
What are the posterior lung auscultation sites?
Above each scapula, then paired sites between the scapulae along the paravertebral lines from about T3 to T7, then below the scapulae to the bases at T10, with a final pair near the posterior axillary line. Avoid placing the stethoscope on the scapula itself.
Where are the lateral lung auscultation sites?
In the midaxillary line, roughly the 4th to 6th intercostal spaces, with the arm raised. On the right this is the best place to hear the right middle lobe; on the left it samples the lingula and lower lobe.
What are the pediatric lung auscultation points?
The same anterior, posterior and lateral sites, using a pediatric or infant chest piece. Listen during quiet breathing or between cries, and because a small chest transmits sounds widely, compare sides carefully before localizing a finding.