. Medical diagnosis for the student and practitioner. conditions (ascites, tympanites,pleural effusion, pneumothorax, etc.). Total transverse measurements Neglectedat dilatations. Manubrialpercussionnote. Corpen-dulum. * Archives of Internal Medicine, May 15, 1920, vol. xxv, No. 2. t Up to the present time the author has encountered no heart exceeding (teleoroent-genographically) 14 cm. in total transverse diameter in the inspiratory phase whosepossessor did not show positive evidence of heart disease. This has held true even inthe case of men of unusual musculature and athletic tendencies. 43
. Medical diagnosis for the student and practitioner. conditions (ascites, tympanites,pleural effusion, pneumothorax, etc.). Total transverse measurements Neglectedat dilatations. Manubrialpercussionnote. Corpen-dulum. * Archives of Internal Medicine, May 15, 1920, vol. xxv, No. 2. t Up to the present time the author has encountered no heart exceeding (teleoroent-genographically) 14 cm. in total transverse diameter in the inspiratory phase whosepossessor did not show positive evidence of heart disease. This has held true even inthe case of men of unusual musculature and athletic tendencies. 43 2 MEDICAL DIAGNOSIS Chiefly rightsventricle and ]auricle. Of utmostvalue. Relation to Anterior Thoracic Wall.—Anteriorly it presents its rightchambers; chiefly the right ventricle to the left of the mid-sternal line, and theright auricle from midsternum to the true right border which it wholly forms. * The left ventricle is normally represented by a mere strip of heart musclealong the left border and the normal left auricle is hardly in Fig. 159.—Drop heart. An extreme example in the adult male,diameter cm. Total transverse Cardiac —Changes in the shape of the relative cardiac dulnessor the radiographic shadow usually indicate enlargement of the heart itself,suggest the individual chambers involved and hence the underlying lesions. As will be seen later, such changed outlines serve as a check upon thediagnosis of valvular lesions and pericardial effusions, and the student must * Save in the drop heart and its minor modifications. THE EXAMINATION OF THE HEART 433 never forget that even serious dilatation thus indicated may be unattended byany valvular murmurs. THE HEART VALVES.—The mitral, tricuspid, aortic and pulmonaryvalves are anatomically located within so small a space that a large stethoscopebell wiU n-early cover them all, but their exact position is of little importance inclinical work. THE CLINICAL VALVULAR AREAS.—The points of maximu
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