Diseases of the chest and the principles of physical diagnosis . .yield a cracked-potsound (p. 69). Percussion is generally less satisfactory than sense of resistance is often a valuable criterion in deciding betweenconsolidation and liquid effusion. The heart is large, lies higher in the thorax, as well as more horizon-tally. Cardiac dulness, therefore, normally extends relatively further tothe left than in adults. It may normally extend >^ inch beyond the mid-clavicular line. Dulness due to the right auricle, however, rarely extendsbeyond the sternal line. The great vesse
Diseases of the chest and the principles of physical diagnosis . .yield a cracked-potsound (p. 69). Percussion is generally less satisfactory than sense of resistance is often a valuable criterion in deciding betweenconsolidation and liquid effusion. The heart is large, lies higher in the thorax, as well as more horizon-tally. Cardiac dulness, therefore, normally extends relatively further tothe left than in adults. It may normally extend >^ inch beyond the mid-clavicular line. Dulness due to the right auricle, however, rarely extendsbeyond the sternal line. The great vessels are relatively large. This,together with the possibility of a persistent thymus gland renders adetermination of the upper border difficult. This difficulty is further. Fig. 113.—Lcxgs of a child. In infancy and childhood the lungs often completelyenvelop the heart, there being in such cases no absolute (superficial) heart dulness. enhanced by the normal dull area at the inner third of the left claviclealready alluded to. During the first year the apex beat is usualh found in the fourthintercostal space. This may be so until the thirteenth year, after whichin normal children, it is always in the fifth interspace. As in adults, theexistence of cardiac hypertrophy can usually be satisfactorily determinedby inspection and palpation alone. If the left ventricle is chiefly in-volved, a hea^ing systolic thrust is felt outside of the mid-clavicular case the right ventricle is chiefly affected, the thrust is diastolic in timeand most marked in the epigastrium because the right ventricle retractsfrom the chest wall to rebound in diastole (Talley). Since compensatoryand reparative changes in jouth are good, marked degrees of cardiach^pertrophyare oft
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
