. A practical treatise on medical diagnosis for students and physicians . Impaired Normal Normal Dulness ^ Flatness Changes in percussion-note. (Le Fevre.) Diminished or Impaired Resonance. The normal tone or resonance isimpaired or muffled in cases of beginning consolidation of the lung, inslight thickening of the pleura, and in small pleural effusions which over-lap the lung as a thin layer. It is the first change toward dulness. Itis particularly noted in the early stages of phthisis, when the lung usuallyis the seat of small areas of tuberculous infiltration at the apex. Dulness. The dull
. A practical treatise on medical diagnosis for students and physicians . Impaired Normal Normal Dulness ^ Flatness Changes in percussion-note. (Le Fevre.) Diminished or Impaired Resonance. The normal tone or resonance isimpaired or muffled in cases of beginning consolidation of the lung, inslight thickening of the pleura, and in small pleural effusions which over-lap the lung as a thin layer. It is the first change toward dulness. Itis particularly noted in the early stages of phthisis, when the lung usuallyis the seat of small areas of tuberculous infiltration at the apex. Dulness. The dull note signifies a relatively small amount of air inproportion to solid structure, the extent and the degree of dulness de- HYPER-EESONA NCE. 485 pending upon the proportion of solid to air-containing material. Moder-ate diilness is seen in tubercular disease, with moderate infiltration of thelung (see Fig. 158), and in small patches of catarrhal pneumonia, in pul-monary congestion and oedema, in phthisis, in condensation of the lung Fig. 158. A. B Chest Wall Transverse section of thorax: A, moderate dulness over tuberculous infiltration; B, height-ening of pitch or Skodaic resonance anteriorly from consolidation (shaded portion) posteriorly.(Original.) from pressure, in carcinomatous infiltration, in atelectasis, and in thepresence within the pleural sac of serum, pus, or lymph not sufficient tocause flatness. Flatness. Absolute or complete dulness, flatness, or deadness, occurswhen air is completely absent, as in the stage of hepatization of acutepneumonia, in hemorrhagic infarction, in phthisis, in interstitial pneu-monia, in carcinoma of the lung, in pulmonary oedema, in pulmonaryabscess, in filled phthisical cavities or circumscribed gangrene, in con-densation from pressure, in pleurisy with large efl\ision, in empyema, inhydrothorax, in great thickening of the pleura, and in tumors. Hyper-resonance. When the resonance is increased, the sound is abnor-mally clear. If it is f
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