. Röntgen ray diagnosis and therapy . of the disease. Theswelling being of a hard nature and the course being slow, atumour was suspected first. Of course, the diagnosis could bewell made without skiagraphy, still it was interesting to note theintegrity of the intrathoracic organs by it. In the case of carcinoma mamma;, described in Chapter XVIIIon Rontgen-Ray Therapy, the beginning metastasis, which was theprecursor of pleuritic exudation, was also shown by the Rontgenmethod. Thus the imminent fatal end was predicted, although thepatient still felt well at that time. CHEST 101 (Esophageal Ste
. Röntgen ray diagnosis and therapy . of the disease. Theswelling being of a hard nature and the course being slow, atumour was suspected first. Of course, the diagnosis could bewell made without skiagraphy, still it was interesting to note theintegrity of the intrathoracic organs by it. In the case of carcinoma mamma;, described in Chapter XVIIIon Rontgen-Ray Therapy, the beginning metastasis, which was theprecursor of pleuritic exudation, was also shown by the Rontgenmethod. Thus the imminent fatal end was predicted, although thepatient still felt well at that time. CHEST 101 (Esophageal Stenosis.—To Localize stenosis of the oesophagus arubber tube containing thin, flexible steel wire in spiral form maybe used, the skiagraph demonstrating where the stoppage of thetube occurs. Most patients, however, will no! tolerate this other-wise effective procedure. Fig. 62 illustrates the stoppage of asound at the point of stricture, caused by carcinoma of the esoph-agus, in a man of fifty-eight years. Gastrostomy was performed,. Fig. 62.—(Esophageal Stenosis Caused by Carcinoma. which prolonged the life of the patient for eighteen months. TheRontgen method permits of differentiation between real stenosis,produced by pathological changes in the oesophagus wall, and con- 102 THE KOXTGEX KAYS tractions, such as may be found in hysteria, caused by disturb-ances of innervation. For fluoroscopic observation it is advisable to administer anopaque substance, like subnitrate of bismuth in a wafer. The tubeis adjusted in front of the patients right shoulder in such a manner that the chest is ir-radiated from the right upperanterior aspect towards theleft lower posterior. The bis-muth (about 15 grains) canbe seen during the act ofswallowing as a marked shad-ow that becomes diffused aftera few seconds; then a portionof it is detected in the area ofstenosis, while the otheroesophageal parts show noth-ing abnormal. In carcinomathe bolus remains at the seatof the stenosis. (Esophageal
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