. Physical diagnosis . sed right lung is seenagainst the spinal column and surrounded by an unnaturally bright area corresponding tothe empty thoracic cavity. The shadow of the heart appears vaguely on the left side of thespine. genuine assistance, as they also do when mapping out the heart inwomen with large breasts and fat chest walls. 3. Central Pneumonia. —Williams and others have succeededin identifying foci of solidification beneath the surface of the lungswhen no other physical signs could be obtained. It must be re- 532 PHYSICAL DIAGNOSIS. membered, however, that congestion of the lung
. Physical diagnosis . sed right lung is seenagainst the spinal column and surrounded by an unnaturally bright area corresponding tothe empty thoracic cavity. The shadow of the heart appears vaguely on the left side of thespine. genuine assistance, as they also do when mapping out the heart inwomen with large breasts and fat chest walls. 3. Central Pneumonia. —Williams and others have succeededin identifying foci of solidification beneath the surface of the lungswhen no other physical signs could be obtained. It must be re- 532 PHYSICAL DIAGNOSIS. membered, however, that congestion of the lung, oedema, atelec-tasis, and pleural thickening produce shadows similar to those ofsolidified lung. 4. Tuberculosis.—It is still a matter of doubt whether tubercu-lous foci can be recognized by the fluoroscope before the disease hasprogressed sufficiently to produce localized rales, diminished breathsounds, or restriction of Littens phrenic phenomenon. Slight opacities have been noted in cases which later turned out. Fig. 239.—Aneurismal Sac, Radiographed from Behind. to be tuberculosis, and which had not previously been diagnosed,but the shadows perceived by the fluoroscope are capable of manyinterpretations and correspond (as above said) to various patholog-ical conditions. Old quiescent foci may appear like advancing le-sions and thus lead to serious errors. We do not want to hurry apatient off to Colorado or Davos on account of the shadow thrown RADIOSCOPY OF THE CHEST. 533 by a long-healed lesion. Further, in some cases of rheumatism,anaemia, debility, and convalescent typhoid, appearances very simi-lar to those of tuberculosis may be found (Williams). Hence theinterpretation of slight lung shadows in cases of suspected incipientphthisis is by no means easy. Advanced phthisis renders the lungs relatively opaque to the sac. Heart.
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