Diseases of the chest and the principles of physical diagnosis . le quality. The impulse is systolic intime and usually consists of a single motion, but may be heaving or un-dulatory in character. A pulsation clue to aneurism is usually in or just ANEURISM OF THE THORACIC AORTA 805 to one side or the other of the median line. Osier gives the followingdescription of impulses which might be mistaken for aneurism: (1) Thethrobbing of the conus arteriosus in the second left interspace-—verycommon in young persons and in thin chests, and seen particularlywell during expiration. (2) Pulsation of the
Diseases of the chest and the principles of physical diagnosis . le quality. The impulse is systolic intime and usually consists of a single motion, but may be heaving or un-dulatory in character. A pulsation clue to aneurism is usually in or just ANEURISM OF THE THORACIC AORTA 805 to one side or the other of the median line. Osier gives the followingdescription of impulses which might be mistaken for aneurism: (1) Thethrobbing of the conus arteriosus in the second left interspace-—verycommon in young persons and in thin chests, and seen particularlywell during expiration. (2) Pulsation of the heart in the second, third,and fourth left interspaces, extending as far as the nipple in cases offibrosis and retraction of the upper lobe of the lung. (3) Cardiac pulsa-tion in the second, third and fourth right interspaces in association withfibrosis and retraction of the right upper lobe. (4) Effusion on eitherside of the chest may so displace the heart that there is a marked impulseat or outside the nipple line on either side. (5) Throbbing subclavians. Fig. 426.—Locations on the anterior chest wiiU at which aneurismal impulses may be notedin their order of frequency. seen in the outer half of the infraclavicular regions; this is seen in thin-chested persons, in neurasthenia, Graves disease, early tuberculosis andanemia. In some instances, when the pulsation is unilateral, it may beaccompanied with a thrill and a murmur forming a mimic or phantomaneurism. (6) In the back of the chest a visible pulsation is nearlyalways aneurismal; but occasionally, in Broadbents sign, the tugging maybe so limited and localized in one interspace that it simulates pulsation,but palpation easily corrects this. In some cases of anemia, in Graves disease and neurasthenia there maybe a diffuse throbbing over the interior portion of the thorax or a distinctsystolic impulse may be noted in the lower part of either side of the pulsation due to a purulent pleural effusion is occasionall
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