. Medical diagnosis for the student and practitioner. inareas. Cyanosis is usually marked and the combination is of decided clinical value in thepresence of fever. THE EXAMINATION OF THE LUNGS AND PLEURAE 30I Pulmonary Edema.—The primary percussion note of lung edema ishyperresonant but in prolonged cases the areas may become airless and thebronchi rilled with liquid, in which event dulness or even flatness may bepresent as in the case of massive pneumonia. Flatness.—This characteristically dead or toneless note indicates denseadhesions, liquid pleural effusions or solid growths in close conta
. Medical diagnosis for the student and practitioner. inareas. Cyanosis is usually marked and the combination is of decided clinical value in thepresence of fever. THE EXAMINATION OF THE LUNGS AND PLEURAE 30I Pulmonary Edema.—The primary percussion note of lung edema ishyperresonant but in prolonged cases the areas may become airless and thebronchi rilled with liquid, in which event dulness or even flatness may bepresent as in the case of massive pneumonia. Flatness.—This characteristically dead or toneless note indicates denseadhesions, liquid pleural effusions or solid growths in close contact with thechest wall. The sound is of great assistance in differentiating the puzzlingcases of pleural effusion in which the breath and voice sounds have almostprecisely the character of those heard in pulmonary consolidation. It isby no means a difficult matter to distinguish between dulness and flatness. The cardiohepatic angle is represented by the resonant area in the rightfifth interspace bounded by the cardiac right border and the hepatic. Fig. 119.—Various forms of pulmonary cavities; incipient tubercular deposits; area of softening. dulness below. Its angular outline is lost to percussion early in pericardialeffusion* (Rotchs sign) right-sided pleural effusions and adhesion, andright-sided basal pneumonia. AUSCULTATION Unilateral vs. Bilateral Variations.—The first law of auscultation demandsthat the test of symmetric breathing shall precede inference. In other words,before concluding that a slight departure from the type of breathing on one siderepresents a pathologic change, the corresponding opposite area should beinvestigated. Slight symmetric departures from the normal are often transientand negligible. Basis of Auscultatory Phenomena.—The art of auscidtation rests uponthe same laws of sound as underlie palpation and percussion. The sound heardwhen the ear is applied to the chest is chiefly produced in the glottic chink,but transmitted and modified by th
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
