Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . e heart. The size and shape of the increase in cardiac dullness,or flatness due to cardiac hypertrophy and dilatation,varying according as the right or left side is of the left ventricle causes the left borderof both dullness .and flatness to be moved to the left andslightly downward. The upper border remains fairlyconstant, while the right border is unchanged. Thearea of dullness over the apex is pointed. When dilata-tion and hypertrophy are associated,
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . e heart. The size and shape of the increase in cardiac dullness,or flatness due to cardiac hypertrophy and dilatation,varying according as the right or left side is of the left ventricle causes the left borderof both dullness .and flatness to be moved to the left andslightly downward. The upper border remains fairlyconstant, while the right border is unchanged. Thearea of dullness over the apex is pointed. When dilata-tion and hypertrophy are associated, the area of flatnessis more quadrangular; the transverse diameter at the PERCUSSION. 283 level of the fourth rib is increased by extension towardthe left, and the outline over the apex is rounded. Inextreme dilatation and hypertrophy of the left heart,as occurs in insufficiency of the aortic valves, the leftborder of flatness may reach the anterior axillary line,and dullness the mid-axillary line. In hypertrophy or dilatation of the right side, whenthe ventricle alone is involved, the upper border of nat- Fig. Percussion outline of cardiac dullness in cardiac dilatation with hypertrophy. ness at the level of the fourth rib shows no marked in-crease. The lower left border is carried slightly out-ward, and the right border remains at the left margin ofthe sternum. When dilatation and hypertrophy affect both ventri-cles and auricles the dullness may be detected beyond theright border of the sternum as high as the fourth costalcartilage. (Fig. 56.) Dilatation and hypertrophy ofthe right heart may cause slight change in the sternal 284 TEE CIRCULATORY SYSTEM. resonance, but not to the same degree as pericardial effu-sion, aneurism, or mediastinal tumors. Percussion of the Aorta.—The great vessels normallygive very slight and hardly perceptible dullness in thesecond interspaces. When any dullness is detected it ismost marked on the right side and is rounded in
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