Diseases of the chest and the principles of physical diagnosis . or this. Thepersistent absence of tubercle bacilli in the sputum, the marked dyspneaand the locaHzation of the physical signs in the anterior mediastinum, aboutthe roots or at the bases of the lungs should serve as warnings. Tubercu-losis is either locahzed at the summit of the lung or if the whole lung isdiseased, the most destructive lesions are found where the process first1 Boston Med. and Surg. Jour., October 28, 1915. 554 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM started, namely, at the apex. Occasionally the ma
Diseases of the chest and the principles of physical diagnosis . or this. Thepersistent absence of tubercle bacilli in the sputum, the marked dyspneaand the locaHzation of the physical signs in the anterior mediastinum, aboutthe roots or at the bases of the lungs should serve as warnings. Tubercu-losis is either locahzed at the summit of the lung or if the whole lung isdiseased, the most destructive lesions are found where the process first1 Boston Med. and Surg. Jour., October 28, 1915. 554 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM started, namely, at the apex. Occasionally the malignant growth isconfined to the upper lobe of the lung (Fig. 325). In such cases a diag-nosis of tuberculosis can be avoided only by giving heed to the negativesputum examinations. —Occasionally cases of malignant disease are encounteredin which there are no localizing signs in the lungs and all that can bedetected is the presence of scattered rales. If the sputum is blood-streaked and does not contain tubercle bacilli and in addition, the heart. Fig. 325.—Malignant disease of upper lobe. Patient from whom this specimen came hadbeen treated in several sanatoria for tuberculosis. (Jefferson Medical College Museum.) shows no evidence of failing compensation, mahgnant disease shouldbe thought of. Extreme dyspnea and cyanosis occurring in a case pre-senting the physical signs of a simple bronchitis are very suggestive ofmalignant disease. Chronic inflammatory conditions of the lung are to be distinguishedfrom malignant disease by their long duration and the absence of severeconstitutional symptoms. Pleural Effusion.—The frequency with which malignant disease ismistaken for a pleural effusion has long been recognized. The causes of DISEASES OF THE LUNGS 555 error lie in the bulging of the affected side, the flat percussion note andthe absence of the voice and breath sounds. Pleural effusion rarelygives rise to pressure symptoms although the displacement of the tho
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
