5
5
5
The orthopercussion(
) method of Plesch is
carried out by flexing the left
middle finger to a right angle,
placing the pulp of the finger
on the area to be percussed,
and then striking the flexed
finger at the distal end of the
first phalanx.
Percussion
The beginner should mark with a skin
pencil where the note changes. The
distance from midsternal line to the left
border should be measured and
recorded, measurement should be made
along a straight line paralleled to the
transverse diameter in the thorax.
Heart borders
Right border of the heart
formed by
sup vena( ),
ascending aorta( ), right
atrium( )
2-3
3.5-4.5
5-6
7-9
Cardiac dullness in
abdominal distention
A variety of pathologic conditions such
as ascites, an ovarian cyst( ),
or peritonitis( ) may cause an
elevation of the diaphragm with an
increase in the area of cardiac dullness.
Changes in position of
cardiac dullness
A left-sided pleural effusion(
) will push the heart to the right, and
increase the cardiac dullness to the right
of sternum, the left border in such cases
can usually not be made out. A rightsided pleural effusion increase the
cardiac dullness on left side.
Cardiac enlargement
Enlargement of the left ventricle
produces an increase in the relative
cardiac dullness to the left and often
downward on this side.
Aortic dilation( ),
aneurysm of aorta( ),
pericardial effusion, all those diseases
may cause the base border of heart
enlargement, so that the base border of
the heart will be widened.
Pericardial effusion
The cardiac dullness is increased in all
directions and assumes the form of a
triangle with the apex at the level of
the first or second intercostal space or a
general globular enlargement.
Adhesive pericarditis
The degree of enlargement depends on
the extent of the adhesive process. The
relative, and especially the absolute,
cardiac dullness are both markedly
increased to left and to the right.
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