. Medical diagnosis for the student and practitioner. Carlandsan le. Fig. 137.—Encapsulated serous pleural effusion. Right pleura after removal of800 of serum (see Fig. 135). with cyanosis or even in extreme cases lividity, and a displacement of the heart Displacedto the opposite side which may carry the visible cardiac impulse to the axillaon the left side or, on the right, nearly to the mid-clavicular line, the beatbeing due in the latter instance to the right ventricle. Occasionally inmoderate left-sided effusion no cardiac impulse is visible. * The bulging interspaces are a clinical cu
. Medical diagnosis for the student and practitioner. Carlandsan le. Fig. 137.—Encapsulated serous pleural effusion. Right pleura after removal of800 of serum (see Fig. 135). with cyanosis or even in extreme cases lividity, and a displacement of the heart Displacedto the opposite side which may carry the visible cardiac impulse to the axillaon the left side or, on the right, nearly to the mid-clavicular line, the beatbeing due in the latter instance to the right ventricle. Occasionally inmoderate left-sided effusion no cardiac impulse is visible. * The bulging interspaces are a clinical curiosity in simple acute exudative pleurisy. 366 MEDICAL DIAGNOSIS Lessenedfremitus. Palpation.—Palpation confirms inspection and reveals absent or diminishedvocal fremitus unless a fibrous adhesion band crossing through the fluid conductssound from the compressed lung and bronchi, or a dislocated bronchus lies incontact with the sternum and conveys the vibration. Resistance andflatness. Fig. 138.—Pleurisy with effusion (same figure as shown under Roentgenography).Note displacement of heart to left. Right lung is undergoing gradual compression, paripassu with accummulation of the exudate. {Dr. Frank S. Bissell.) Percussion.—Palpatory percussion best reveals the absolute resistance overthe exudate and simple percussion elicits a flat note, decidedly differing fromthat of consolidation and simulated only by pleural growths and dense pleuraladhesions. Just above the level of the fluid anteriorly, the note is often hyper-resonant or tympanitic in quality (skodaic resonance). DISEASES OF THE LUNGS AND PLEURA 367
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
