. The heart and the aorta; studies in clinical radiology . ase of absolute dullness. Auscultation: diastolic murmur at the aortic areatransmitted along the right border of the sternum;double crural murmur. Pulse regular, bounding, 54 pulsations a minute. Systolic tension, 16-17 (sphygmo-signal). Liver slightly enlarged, overlapping the false ribs twofingerbreadths. Clinical diagnosis: aortic insufficiency, pericardialsymphysis. Radiological examination: Dimensions of the heart. Area of projection, 127square centimeters. Left side, cm. long; right side, cm. Longitudinal diameter, c
. The heart and the aorta; studies in clinical radiology . ase of absolute dullness. Auscultation: diastolic murmur at the aortic areatransmitted along the right border of the sternum;double crural murmur. Pulse regular, bounding, 54 pulsations a minute. Systolic tension, 16-17 (sphygmo-signal). Liver slightly enlarged, overlapping the false ribs twofingerbreadths. Clinical diagnosis: aortic insufficiency, pericardialsymphysis. Radiological examination: Dimensions of the heart. Area of projection, 127square centimeters. Left side, cm. long; right side, cm. Longitudinal diameter, cm.; horizontaldiameter, cm. Apex rounded, lowered, pushed out-ward. Marked hypertrophy of the left ventricle (). Respiratory displacements of the heart. During deepinspiration and expiration, the displacements of the heartcontours are very marked; they are normal on the right,but on the left side, especially the middle part, they are 188 THE HEART AND THE AORTA very great, whereas there are no displacements at thelevel of the apex (Fig. 141).. Fig. 140. TH. L. SYMPHYSIS OF THE APEXAortic insufficiency. Hypertrophy of the left ventricle. Apex of the heart. It is immobile during left lateralinclination. When the patient is inclined far to the left,the contour of the shadow of the left ventricle, above theapex, approaches the external thoracic wall. Movements of the diaphragm. During deep inspira-tion, the right diaphragm is depressed cm., whereasthe left has a reduced displacement of about cm. (). Outline of the heart. In lateral position at 90 degrees,the retro-sternal clear space is not visible in its lowerthird, even during forced inspiration. Respiratory outline. Form normal, ample. No abnormal shadows on the heart contour, nor in thepulmonary field. Conclusion. Signs of adhesions of the heart apex. Itsimmobility and the greatly reduced movements of the leftdiaphragm can be explained only by the fixation of theapex to the anterior thoracic wall on o
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