. Medical diagnosis for the student and practitioner. liver, if mere anterior palpationis employed and the antero-posteriorbimanual method neglected. The epigastric pulsation is usuallysomewhat wavy and less determinate thanthe heave of a greatly enlarged leftventricle, as seen over the left thorax inaortic lesions. Variations in hepatic outline corresponding to the degrees of stasis areextremely marked, jaundice is common and nutmeg liver is often encountered. Systolic retraction of the lower interspaces to the left of the sternum is usuallya marked feature, attributable to the systolic retra
. Medical diagnosis for the student and practitioner. liver, if mere anterior palpationis employed and the antero-posteriorbimanual method neglected. The epigastric pulsation is usuallysomewhat wavy and less determinate thanthe heave of a greatly enlarged leftventricle, as seen over the left thorax inaortic lesions. Variations in hepatic outline corresponding to the degrees of stasis areextremely marked, jaundice is common and nutmeg liver is often encountered. Systolic retraction of the lower interspaces to the left of the sternum is usuallya marked feature, attributable to the systolic retraction of the anterior4wallof the enlarged right ventricle, and in mitral stenosis especially, or cases ofprimary right ventricular hypertrophy and dilatation, the true systolicvisible apex impulse of the left ventricle may be submerged, owing to theinability of the left chamber to reach the thoracic wall. In such instances the wavy, diffused indeterminate right ventricularimpulse is characteristic. In combined mitral tricuspid and aortic lesions a. Diastole. Systole. Fig. 381.—Phantom-pulse in pul-monary veins. This fluoroscopicphenomenon is occasionally demon-strable, under a special technic, inmitral cases with tricuspid insuffi-ciency, showing the positive (systolic)jugular pulse, of which this hilus flowand ebb is the pulmonary counter-part. {Schematic; after Schwarz.) j AORTIC INSUFFICIENCY 707 curious combination of presystolic undulations over the right ventricle andsystolic heave over the left may be encountered. Slight or Silent Leakages.—It must be remembered that slight leakagesmay be evident in the murmur only, all secondary signs failing, and that eitherslight or large leakages may be wholly silent for the reasons hitherto assigned. Only a small percentage of the total tricuspid insufficiencies presentduring life are recognized either ante- or post-mortem, though a more carefulstudy of the venous pulse and second pulmonary tone would uncover manyat present over
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
