This figure shows the conditions affecting percussion of the normal chest. (a) Variation in shape and volume of the two lungs. (b) Modified resonance due to ribs and sternum overlying pulmonary tissue. (c) The uselessness of percussion near the spinous processes of the vertebral column. FIG. 58.-EMPHYSEMA. The distended air-cells and voluminous lungs are clearly shown. FIG. 59.-MALIGNANT GROWTH (LEFT) AND PULMONARY ABSCESS (RIGHT). The larger mass on the left side involves a bronchus, and would yield signs of consolidation. The anterior superficial mass would present only dullness, diminished voice and breath sounds, with defective lung movement on affected side. Such abscesses as are here shown present few recognizable physical signs, and are often overlooked. FIG. 60.-PNEUMOTHORAX (LEFT) AND ENCAPSULATED FLUID (RIGHT). Especial attention should be directed to the compressed lung in the larger effusion. FIG. 62.-LOBAR PNEUMONIA (LEFT); CENTRAL PNEUMONIA (RIGHT). The lobar consolidation on the right side would present the classical signs of complete solidification with patent bronchi. The central area of consolidation would yield no percussion signs, and be chiefly denoted by distant tubular breathing obscured by the vesicular murmur of overlying lung-cells. symmetrical, although there is invariably a slight difference between the two sides, the right or left side being slightly larger than its fellow, corresponding to the right- or left-handedness of its FIG. 63.-VARIOUS FORMS OF PULMONARY CAVITIES; INCIPIENT TUBERCULAR DEPOSITS; AREA OF SOFTENING (RIGHT INFERIOR). owner. The following summary will serve to indicate the most important variations from the normal form: |