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December 8, 1923


JAMA. 1923;81(23):1952-1953. doi:10.1001/jama.1923.26510230002012b

During a fluoroscopic examination at the Bronx Hospital of the chest of a colleague, who about nine months previously had suffered from a serofibrinous pericarditis from which he had apparently completely recovered, I observed a rhythmic tug of a part of the left dome of the diaphragm near its center with each systole of the heart when the diaphragm was fixed in an inspiratory pause. This tug I interpreted as a sign of a pericardial symphysis, even when present only to a slight extent, because no other evidence of an adherent pericardium was present in that case. This sign is elicited during an inspiratory pause because "the fibrous pericardial sac is inserted over the dome of the diaphragm and adheres closely to the phrenic center. It gives only an inappreciable fluoroscopic shadow above the left portion of the diaphragm. This shadow disappears entirely in forced inspiration, the heart being then

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