Principles And Practice of Physical Diagnosis

Cover Principles And Practice of Physical Diagnosis
Principles And Practice of Physical Diagnosis
John C Da Costa
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The affected side is distended and immobile, the intercostal spaces being effaced and the diaphragm shadow abolished, while in contrast to this the opposite half of the thorax shows exaggerated respiratory movements. The visible cardiac impulse is displaced toward the sound pleura, and the liver may bulge outward below the right costal margin. Distressful dyspnea, . Paroxysmal cough, cyanosis, rapid feeble pulse, and a state of suffocation and collapse are notable objective symptoms of acute ge...neral pneumothorax, but in cases of long standing the urgency of these signs is greatly modified.
Fluoroscopic examination reveals an abnormally clear and bright appearance of the affected side, with contrasting shadows of carnified lung above and of fluid below, in case these attendant conditions be sufficiently developed to obstruct the passage of the rays (Fig. 116). The mediastinal shadow lies far from its natural site, and the diaphragm is depressed and unnaturally immobile. In some cases the phrenic vault shows a downward convexity, and the normal inspiratory fall and expiratory rise of the diaphragm are reversed.


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