In books on physical diagnosis, attention frequently is called to dulness and bronchial breathing in an area of varying size in the left back just in the region of the angle of the scapula or below it as an accompaniment of pericardial effusion. For example, Musser,1 under the heading of "Pericardial Effusion," says:
Pulmonary resonance is modified posteriorly. At the angle of the scapula is a small area of dulness, increased vocal fremitus and bronchovesicular and bronchial breathing when the patient is sitting upright, which disappears when he leans forward (Bamberger's sign). The dulness in large effusion includes the axillary region so that it may simulate pneumonia or pleural effusion.
Roberts2 thus discusses these pulmonary signs in pericardial effusion:
In considerable pericardial effusion, the condition of the left lung may give rise to a definite group of signs at the back of the chest on that side; namely,
CHRISTIAN HA. THE FREQUENCY OF PULMONARY COMPRESSION SIGNS IN ACUTE FIBRINOUS PERICARDITIS. JAMA. 1918;71(6):419–422. doi:https://doi.org/10.1001/jama.1918.02600320003002
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