Diseases of the chest and the principles of physical diagnosis . ; fluoroscopic examination showed verylittle diaphragmatic movement on either side and on the left side thephrenocostal sulcus was obliterated by adhesions (Fig. 372). Physical Signs.—Immobility of the diaphragm is seen in its mostcharacteristic form following a pleural effusion. If the effusion hasbeen present but a few days the lung quickly expands and in the courseof a few days little change is to be noted. In these cases it is probablethat the diaphragm has escaped with little or no injury. On the otherhand, if the effusion h
Diseases of the chest and the principles of physical diagnosis . ; fluoroscopic examination showed verylittle diaphragmatic movement on either side and on the left side thephrenocostal sulcus was obliterated by adhesions (Fig. 372). Physical Signs.—Immobility of the diaphragm is seen in its mostcharacteristic form following a pleural effusion. If the effusion hasbeen present but a few days the lung quickly expands and in the courseof a few days little change is to be noted. In these cases it is probablethat the diaphragm has escaped with little or no injury. On the otherhand, if the effusion has been present for some time the most marked 1 hoc. cit. DISEASES OF THE DIAPHRAGM 645 physical signs persist at the base of the affected chest in spite of the re-moval of a large amount of fluid. The usually accepted teaching has beenthat the lung has failed to expand. While this is in a measure true themajor portion of the difficulty is to be ascribed to crippling of the functionsof the diaphragm. This may be transitory in character or it may Fig. 372.—The dense shadows at both bases are due to a chronic blastomycosis. Bothleaflets are high and on fluoroscopic examination show scarcely any motion. Patient sub-ject to frequent attacks of dyspnea. {Roentgenogram by Dr. H. K. Pancoast.) Absence of Littens sign, restriction of motion, dulness on percussionand distant or suppressed breath sounds are the most prominent of thephysical signs. The most certain method of determining the condition of the dia-phragm and its functional capacity is direct inspection by means of thefluoroscope or a radiograph. In -pulmonary tuberculGsis, even when the disease is confined to a hmitedarea in one apex, the diaphragm on the affected side often shows a dimin- 646 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM ished inspiratory descent when examined with the fluoroscope. Thisis known as Williams early diaphragmatic sign. Walsham and Over-end^ offer the following explanat
Size: 1582px × 1580px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
