... interstitial edema or fibrosis, diaphragmatic dysfunction, or impaired chest wall motion) The pulmonary parenchyma should be examined for evidence of interstitial disease and emphysema Prominent pulmonary ... sign of emphysema); and auscultation (wheezes, rales, rhonchi, prolonged expiratory phase, diminished breath sounds, which are clues to disorders of the airways, and interstitial edema or fibrosis) ... pressures (jugular venous distention, edema, accentuated pulmonic component to the second heart sound); left ventricular dysfunction (S3 and S4 gallops); and valvular disease (murmurs) When examining...