. The diseases of children : medical and surgical. adherent to the pericardium, the space between the two becomingobliterated. In some cases a subacute or chronic inflammatory process goeson in the mediastinum, involving the serous membranes, connective tissue, F. E 4i8 Diseases of the Circulatory System and perhaps the mediastinal glands, so that a matting of all the parts takesplace, the edges of the lungs, pericardium, and great vessels being firmly boundtogether. The pericardium may be adherent to the walls of the heart, theremay be extensive pleuritic adhesions of one or both lungs, and t
. The diseases of children : medical and surgical. adherent to the pericardium, the space between the two becomingobliterated. In some cases a subacute or chronic inflammatory process goeson in the mediastinum, involving the serous membranes, connective tissue, F. E 4i8 Diseases of the Circulatory System and perhaps the mediastinal glands, so that a matting of all the parts takesplace, the edges of the lungs, pericardium, and great vessels being firmly boundtogether. The pericardium may be adherent to the walls of the heart, theremay be extensive pleuritic adhesions of one or both lungs, and the adhesionsin some cases are tough and firm and of almost cartilaginous hardness. The etiology of these cases is uncertain. Many cases are associated withchronic tuberculosis of the lung or with caseous mediastinal glands ; inothers no evidence of tubercle can be found, a simple chronic inflammationof the connective tissue going on, ending in cicatrisation. The immediateresult of this process is to hamper the action of the heart, preventing its. Fig. 80.—Chronic Mediastino-pericarditis. Boy 13 years (see case, p. 419). The anterioredges of the lungs were adherent ; in front there were indurated adhesions in the anteriormediastinum. complete systole, to interfere with the filling of the lungs during inspiration,and to compress the large veins | entering the chest. The liver becomesconstantly engorged, the hepatic system of veins dilated, and a perihepatitisresults. Symptoms.—The course of this curious affection is very chronic. Inwell-marked cases the symptoms are those which are likely to be caused byan obstruction to the flow of blood into the chest. Dyspnoea on exertion,cyanosis of the face, clubbing of the fingers, distension of the veins of theneck, chest, and abdomen during inspiration, and, later, cedema of the face,arms, feet, and abdomen. There may be signs of pulmonary tuberculosis Mediastino-pericarditis, Pleuro-pericarditis 419 The pulsus paradoxus—i. e. the p
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