. Physical diagnosis . present in the pericardium, ormay be so great as to embarrass the cardiac movements and finallyto arrest them altogether. In chronic (usually tuberculous) cases,the pericardium may become stretched so as to hold a quart or morewithout seriously interfering with the hearts action, while a muchsmaller quantity, if effused so rapidly that the pericardium has notime to accommodate itself by stretching, will prove rapidly fatal. Hydropericardium denotes a dropsy of the pericardium occurringby transudation as part of a general dropsy in cases of renal disease orcardial weaknes
. Physical diagnosis . present in the pericardium, ormay be so great as to embarrass the cardiac movements and finallyto arrest them altogether. In chronic (usually tuberculous) cases,the pericardium may become stretched so as to hold a quart or morewithout seriously interfering with the hearts action, while a muchsmaller quantity, if effused so rapidly that the pericardium has notime to accommodate itself by stretching, will prove rapidly fatal. Hydropericardium denotes a dropsy of the pericardium occurringby transudation as part of a general dropsy in cases of renal disease orcardial weakness. The physical signs to which it gives rise do notdiffer from those of an inflammatory effusion, and, accordingly, allthat is said of the latter in the following section may be taken asequally an account of the signs of hydropericardium. 256 PHYSICAL DIAGNOSIS Haemopericardium, or blood in the pericardial sac, due to stabs orto ruptures of the heart, is usually so rapidly fatal that no physicalsigns are Fig. 170.—Pericardial Effusion, Cardio-hepatic Angle obtuse. (From v. Ziemssens Atlas.) Physical Signs of Pericardial Effusion. In most cases a pericardial friction rub has been observed prior tothe time of the fluid accumulation. The presence of fluid in thepericardial sac is shown chiefly in three ways: (1) By percussion, which demonstrates an area of dulness more orless characteristic (see below). (2) By auscultation, which may reveal an unexpected feebleness inthe heart sounds when compared with the power shown in the radialpulse. (3) By the signs and symptoms of pressure exerted by the peri-cardial effusion upon surrounding structures. Bulging of the precordia is occasionally to be seen in children; inadults we sometimes observe a flattening of the interspaces just to theright of the sternum between the third and sixth ribs. (1) The Area of Percussion Dulness.—The extent of the dull areadepends not only on the size of the effusion and the position of the
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectdiagnos, bookyear1912
