Diseases of the chest and the principles of physical diagnosis . d escapes detectioneven when a needle is repeatedly introduced. This may be due to theneedle being too short, to the fact that the puiulent material is too thick,or what is probably more often the case the phjsical signs fail to locatethe pus sufficiently accm^atelj. It is in this type of case that the X-rajsare invaluable and without their aid it would be impossible to be certaineither as to the presence of or the location of many of these effusions. In the recent epidemic the number of encysted effusions was notablyhigh. Of 35
Diseases of the chest and the principles of physical diagnosis . d escapes detectioneven when a needle is repeatedly introduced. This may be due to theneedle being too short, to the fact that the puiulent material is too thick,or what is probably more often the case the phjsical signs fail to locatethe pus sufficiently accm^atelj. It is in this type of case that the X-rajsare invaluable and without their aid it would be impossible to be certaineither as to the presence of or the location of many of these effusions. In the recent epidemic the number of encysted effusions was notablyhigh. Of 35 empyemas operated on by Deaver in the University andLankenau Hospitals; 24 were locahzed, 10 were diffuse and one wasan empyema necessitatis. Of the 24 which were locahzed, 13 wereinterlobar. In some instances the empyema has been caused by the rupture of apulmonary abscess into the pleural cavity. Such an accident may besuspected, if during convalescence the patient is seized with a sudden,sharp pain in the chest and in a few hours becomes critically ill. The. Pig. 298.—Effusion following lobar pneumonia. Often mistaken for unresolved pneu-monia. (Medical Clinics of Xorth America.) temperature rises sharply, the pulse becomes rapid and small and thebreathing shallow and very painful. The pain is usually located in thelower chest and upper abdomen. The abdomen is apt to be distendedand markedly tympanitic. The presence of fluid may be made outat the base of the affected side. Bro}—Dilatation of the bronchi may occur as an acuteprocess during the course of the primary infection (see Fig. 283). It isencountered more often as a remote sequel, the symptoms and signsof the condition becoming manifest several years after the influenzaattack. The condition arises as a result of the bronchitis and peri-bronchitis produced by the influenza bacillus. The bronchial waU be-comes softened and readily distended. As already pointed out thissoftening may be so marked as to lead
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