On the diagnosis of pericardial effusion: With special reference to physical signs on the posterior aspect of the thorax

Abstract

In the preceding pages I have attempted to show that: (1) The results of the experimental injection of the normal pericardium after death, with respect to the distribution of the liquid in the sac and to the amount the distended sac will contain, cannot safely be applied to the clinical condition of pericarditis with effusion. In the latter state the quantity of liquid is often vastly greater and the shape of the distended sac entirely different. (2) A pericardial friction sound not only may be, but usually is, present when the pericardium contains a large quantity of exudate. (3) A visible and palpable cardiac impulse and apex beat also are quite compatible with the presence of a large effusion. (4) In large effusions signs suggestive of those of pleurisy with effusion are regularly found, not only over the left back, but over the right back as well. (5) On the right side these signs are sometimes present when the appearance of the x-ray films indicates that the right pouch of the pericardium contains only a relatively small quantity of liquid. (6) In such cases the signs probably are produced as they are supposed to be in Grocco's triangle of dulness in pleural effusion.