Physical Signs in the Chest Part II

Abstract

In this section some of the causes of the common physical signs are listed.

Mediastinal shift.

Mediastinal shift to one or other side is detected by deviation of the trachea or of the heart.  Naturally the trachea is more often deviated be abnormalities in the upper part of the chest, or occupying the whole of one side of the chest, and the heart by abnormalities in the lower part of the chest.  If the heart is deviated to the left the apex beat will be deviated to that side.  If there is no obvious cause of enlargement of the heart one can provisionally assume, depending on the later detection of consistent physical signs, that deviation is due to mediastinal shift.  It is less easy to be sure of deviation to the right, especially if the abnormal physical signs are present in the right lower zone and dullness at the right base makes it impossible to detect the right border of the heart.  Inward deviation of the apex beat, unless it is gross, might be due to the patient having a relatively small heart.  In this case initial impressions may have to confirmed by x-ray.