Royal Infirmary cliniques . astic air-containing right lung readily yielding to anyenlargement of, or movement of, the heart to the right, andas readily following any diminution of, or movement of, theheart to the left. But now supposing that along the zigzagline D (see Fig. 2) the heart be fixed, by pleuritic, pericardial, 1 LEnvpyenie, Paris, 1888. 2 LEmpyeme Pulsatile, Paris, 1895. 18 PULSATING EMPYE:\IA. or mediastinal adhesions, and supposing that the fluid c in the left pleural cavity be in free communication with a subcutaneous abscess cavity F, it is evident that the mechanical conditi
Royal Infirmary cliniques . astic air-containing right lung readily yielding to anyenlargement of, or movement of, the heart to the right, andas readily following any diminution of, or movement of, theheart to the left. But now supposing that along the zigzagline D (see Fig. 2) the heart be fixed, by pleuritic, pericardial, 1 LEnvpyenie, Paris, 1888. 2 LEmpyeme Pulsatile, Paris, 1895. 18 PULSATING EMPYE:\IA. or mediastinal adhesions, and supposing that the fluid c in the left pleural cavity be in free communication with a subcutaneous abscess cavity F, it is evident that the mechanical conditions will be quite reversed. Increase or diminution in the size of the heart, or movement of any part of it to right or left in systole or diastole, will readily affect the fluid effusion. This can be because the fluid in the pleural cavity will readily yield and recoil with the cardiac movements, being now in free communication with the fluid in the subcutaneous cavity, the walls of which are distensile and elastic. Fig, Section of thorax at same level. At d adhesions between the pericardium and pleurahave occurred, followed by bulging of the effusion through the chest-waU. Hence, we should conclude that in pulsating empyema ofnecessity the factors which bring about the pulsation are (1)fixation of the heart, and (2) distensibility and elasticity ofthe walls of the empyema sac. But it will now be asked, How is the existence of pulsa-tion in intrapleural empyemas or in other intrapleural fluidcollections to be explained ? To this I would answer thatthe factors are practically the same. The heart must bemore or less fixed, as in the former case, whilst the yieldingand recoiling of the fluid to its movements may be due to PULSATING EMPYEMA. 19 such conditions as the presence of air in the pleural cavity,to the existence of a portion of semi-inflated lung, to ayielding and elastic diaphragm, to the yielding of the inter-spaces through paralysis of the intercostal muscles, or ev
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