Differential Diagnosis 1

Cover Differential Diagnosis 1
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The right chest is flat below the fourth rib in front and midscapula behind. Over this area respiration is absent, likewise voice and fremitus.
Discussion. — As this patient has previously had pleurisy on the right side, we need to consider whether the organized results of that attack — pleural adhesions — might account for the symptoms which are now present. I should say decidedly not. An inflammation which has en- tirely died out thirty-six years earlier does not lead to acute pain. The pain
...of a pleural effusion may linger on for months, or even for a year or two, but never for thirty-six years. Pleural adhesions may cause dul- ness and diminished breathing, but not flatness and absent breathing.
Can the trauma of October, 1907, be the cause of the present trouble?
The interval of five months between the time of the blow and the onset of the present pain makes this rather unlikely. Hemothorax never results, so far as I know, from an injury of this kind without fracture of a rib or puncture of the pleura.


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