. A practical treatise on medical diagnosis for students and physicians . ide of the sternum above the levelof the third rib, most commonly in the second interspace on the rightside. The impulse may be seen alone without visible swelling; thechest must be viewed from different situations in order to detect it. Anoblique light falling on the surface is sometimes necessary. When theinnominate artery is involved, the pulsation is observed in the neck, abovethe sternoclavicular junction or above the sternum. With the abnormal impulse a swelling or tumor is often present. Itmay be sufficiently larg
. A practical treatise on medical diagnosis for students and physicians . ide of the sternum above the levelof the third rib, most commonly in the second interspace on the rightside. The impulse may be seen alone without visible swelling; thechest must be viewed from different situations in order to detect it. Anoblique light falling on the surface is sometimes necessary. When theinnominate artery is involved, the pulsation is observed in the neck, abovethe sternoclavicular junction or above the sternum. With the abnormal impulse a swelling or tumor is often present. Itmay be sufficiently large to press the upper portion of the sternum andadjacent ribs forward. In other instances a tumor the size of the halfof a lemon may be seen along the edge of the sternum. The mostfrequent site is the first and second right, or the second left skin over the tumor, as in the case of which an illustration isgiven, may ulcerate and be the seat of persistent small apex-beat of the heart is displaced downward and outward frompressure. Fig. Possible positions of impulse in aneurism, arranged in order of frequency. If the aneurism is seated in the ascending portion of the aorta, justbeyond the aortic ring, a pulsating tumor may be seen in the third inter-space at the right edge of the sternum. If in the ascending portion,beyond the heart, the tumor is in the first or second interspace along theright edge of the sternum. If the aneurism is in the transverse portionof the aorta, the upper portion of the sternum is frequently made toprotrude, or the tumor projects upward into the fossa of the neck. If inthe descending portion, it is in the second or third interspace on the leftside. In this portion of the aorta a tumor is seen in the left scapularregion in rare instances. Palpatiox. Palpation must be employed by the usual method;bimanual palpation must also be used, one hand placed upon the sternumand the other upon the vertebme. Moderate pressure shou
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