. The heart and the aorta; studies in clinical radiology . E CASE Equally marked diminution of the excursion of the diaphragm in recum-bency. phragm and the heart much less in the vertical positionthan in recumbency. If the heart is large, as is generallythe case in cardiac symphysis, the organ, by its ownweight, depresses the diaphragm, especially on the left,and obstructs its movements. In order to make sure thatthe decrease of excursion is not due solely to this cause,a second observation in recumbency should be made, theposition in which the weight of the heart has no effect. Ifas marked a
. The heart and the aorta; studies in clinical radiology . E CASE Equally marked diminution of the excursion of the diaphragm in recum-bency. phragm and the heart much less in the vertical positionthan in recumbency. If the heart is large, as is generallythe case in cardiac symphysis, the organ, by its ownweight, depresses the diaphragm, especially on the left,and obstructs its movements. In order to make sure thatthe decrease of excursion is not due solely to this cause,a second observation in recumbency should be made, theposition in which the weight of the heart has no effect. Ifas marked a reduction of the movements is found, thenthe hypothesis that adhesions reduce the excursion of thediaphragm (Figs. 133 and 134) can be considered. AFFECTIONS OF THE PERICARDIUM 179 By examining the movement of the diaphragm, themechanism of a sign described by Broadbent,39 which con-sists in the systolic retraction of the posterior thoracicwall at the level of the lower ribs, can also be can be done by fixing an opaque index over the region. Fig. 135. PATIENT EXAMINED IN SLIGHTLY OBLIQUE POSITION(EIGHT ANTERIOR) On the left thoracic contour the shadow of the lead index is shown situatedin the zone in which appears Broadbents sign. In dotted lines, the contourof the diaphragm stretched at each systole. of the maximum movement of retraction; then it is seen,if the patient is placed obliquely, that this index corre-sponds exactly to the posterior costal insertions of thediaphragm and that the muscle is under tension at eachcardiac contraction (Fig. 135). It is necessary, then, toobtain Broadbents sign, that the heart and the pericar-dium should adhere not only to the diaphragm but alsoto the anterior thoracic wall. However, this sign is ofno pathognomonic value. It is found independent of car-diac symphysis when pleural adhesions diminish the dia-phragmatic movement and when the heart, increased in 39 Broadbent, Diseases of the Heart, London, 1897. 180 THE HEART AND
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