Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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possible to diagnose foreign body upon the presence of an emphysemaon the affected side. t Exudative Pleuritis.—(Pleuritis exudativa).—This presents a variableroentgen picture, according to the size and position of the exudate, itscharacter, and many other factors. There may be marked displacement of the neighboring organs with relativelylittle exudate, or the reverse may be true. While easy to recognize in typical cases, one may meet with some difficulty Value ofclinical data. More distinctand massive. Necessaryprecaution. Multiple bron-chiectases. Characteristicshadow. Metastases. Localization. Visceraldisplacement. 322 MEDICAL DIAGNOSIS Surmounting diagnostic obstacles. Smalleffusions. in those complicated by old fibrous thickening of the pleura the shadow ofwhich may cover that of the fluid. Here the fluoroscopic screen is muchsuperior to the roentgenogram, because one may observe the effect of respira-tion and of change of position upon the density of the shadow. Even a small
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Fig. 130.—Pleurisy with effusion. Xote density of fluid shadow and its horizontalupper border. Xote also cardiac displacement. (Dr. Frank S. Bissell.) exudate may usually be recognized early as it fills the complementary pleuralsinuses, obliterates the phreno-costal angle, and interferes with the normalexcursion of the diaphragm of the side affected. As the fluid increases inquantity, one notes its tendency to climb along the lateral wall toward theaxilla. This is the so-called curve of Damoiseau. This curve tends to ROENTGENOGRAPHS EXAMINATION OF LUNGS AND PLEURAE 323 disappear as the upper level of the fluid descends to a point below the lunghilus. It also disappears when the patient is in the horizontal position. The heart and other mediastinal organs may become displaced toward theopposite side before the exudate has become large enough to exert direct pressure. This displacement is the result of an elastic pull of the normal lung, thecompressed lung of the affected side having

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