Diseases of the chest and the principles of physical diagnosis . ces. One lies between the pericardium and the dia- DISEASES or THE DIAPHRAGM 631 phragm and is called the phreno-pericardial angle; it is usually moremarked on the right side. The other space lies between the outer edgeof the diaphragm and the costal surface. This is known as the phreno-costal space or sulcus (Fig. 365). These two spaces disappear duringexpiration but during inspiration and flattening of the diaphragm theyreappear. The obliteration of these spaces, especially the phreno-costal,points to adhesions or immobility of
Diseases of the chest and the principles of physical diagnosis . ces. One lies between the pericardium and the dia- DISEASES or THE DIAPHRAGM 631 phragm and is called the phreno-pericardial angle; it is usually moremarked on the right side. The other space lies between the outer edgeof the diaphragm and the costal surface. This is known as the phreno-costal space or sulcus (Fig. 365). These two spaces disappear duringexpiration but during inspiration and flattening of the diaphragm theyreappear. The obliteration of these spaces, especially the phreno-costal,points to adhesions or immobility of the diaphragm, or both. The actionof the diaphragm is much more pronounced in men than in women, al-though occasionally, as in the case of trained singers, the diaphragmaticaction in women is similar to that of men. Furthermore, in athleticmen the excursions of the diaphragm are much greater than in those ofsedentary habits. Rarely marked muscular hypertrophy may occur as the result of over-work caused by long standing abdominal distention (Fig. 366). Rolles-. FiG. 365.—Diaphragm. Posterior view. AA, indicate phrenocostal spaces which arefrequently obliterated by adhesions. Heart is seen resting on the diaphragm. Thephrenopericardial angle (more marked on right side) is also frequently obliterated byadhesions. ton^ refers to a patient in whom marked hypertrophy of the diaphragmwas found in association with cirrhosis of the liver and for which theMorison-Talma operation had been performed. The nerve supply of the diaphragm is through the phrenic nervesand the intercostals (sixth to twelfth). The great importance of thediaphragm in the respiratory process can be realized from the fact thatbilateral action of the phrenic nerves in j^oung rabbits is followed bydeath (Landois). A knowledge of the nerve distribution is important aspain, the result of inflammatory or other conditions, is not common inthe diaphragm itself. The pain is usually referred to some distant pai
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
