. Physical diagnosis . , corresponding to the palpablediastolic shock, is generally to be heard in the aortic region. If a portion of either lung is directly pressed upon by the aneurismal 268 PHYSICAL DIAGNOSIS sac, we may have the signs of condensation of the lung in the areapressed upon (slight dulness, broncho-vesicular breathing, andexaggerated voice sounds). If one of the primary bronchi is pressedupon, as occasionally happens, atelectasis of the corresponding lungmay be manifested by the usual signs (dulness, absence of tactilefremitus and of respiratory and vocal sounds). Since aneuris
. Physical diagnosis . , corresponding to the palpablediastolic shock, is generally to be heard in the aortic region. If a portion of either lung is directly pressed upon by the aneurismal 268 PHYSICAL DIAGNOSIS sac, we may have the signs of condensation of the lung in the areapressed upon (slight dulness, broncho-vesicular breathing, andexaggerated voice sounds). If one of the primary bronchi is pressedupon, as occasionally happens, atelectasis of the corresponding lungmay be manifested by the usual signs (dulness, absence of tactilefremitus and of respiratory and vocal sounds). Since aneurism is frequently associated with regurgitation at theaortic valve, a diastolic murmur is not infrequently to be heard. If the aneurismal sac is of very great size, the pulse wave in thefemorals may be obliterated, as happened in a case described by Osier. IV. Radioscopy. With the fiuoroscope and through radiography one can oftenmake out a shadow corresponding to the position of the aneurism. From the front. From Fig. 177.—Radiograph of Case whose Photograph is Reproduced as Figs. 174 and the right-hand cut are shown the appearances seen from behind. The left-hand cut,A, A. aneurismal sac; B, heart displaced; C, liver (not in focus). The position of the shadow is best explained by reference to , 178, 179, and 180. Summary. The most important signs of aneurism are: 1. Abnormal pulsation—visible or palpable 2. Tumor over which a 3. Thrill and a THORACIC ANEURISM 269 Diastolic shock may be felt. Tracheal tug. Pressure signs (unequal pulses, pupils, hoarseness, pain, etc.), Dulness on percussion over the suspected area. Loud, low-pitched aortic second sound. Systolic murmur (least important of all).
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