The diagnosis of emphysema: a physical sign, a roentgenographic sign, and an oximeter test.

Abstract

The difficulties encountered in making a diagnosis of diffuse obstructive emphysema have often been stressed. The only essential symptom is dyspnea, which is often found in many other conditions. The diagnosis of emphysema from physical signs is not easy. Fletcher (1) reported the experience of eight physicians who were particularly interested in emphysema and who were asked to examine twenty patients with emphysema. There was considerable disagreement about the presence and absence of physical signs such as barrel-chest, wide subcostal angle, kyphosis, use of accessory muscles of respiration, impaired chest expansion, movement en bloc, generalized hyperresonance, impaired cardiac dullness, absent apical impulse, and impaired breath sounds. It was concluded that by careful definition of some of the signs agreement might be increased, but that the clinical diagnosis of emphysema could not be made with any confidence except perhaps in the most advanced cases. The claim that emphysema presented a characteristic roentgenographic appearance has been challenged. Knott and Christie (2) submitted roentgenograms of twenty patients with moderate or advanced emphysema and those of twenty normal subjects to a physician and three radiologists, all of whom had special experience in this field. When given postero-anterior and lateral films in full inspiration and full expiration, all observers correctly diagnosed 70 per cent of the emphysematous and 80 per cent of the control subjects. The films were then re-submitted, but only the full inspiration postero-anterior and lateral views were supplied. Of the group with