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February 3, 1923


JAMA. 1923;80(5):321. doi:10.1001/jama.1923.26430320003011b

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Abdominal signs and symptoms in diaphragmatic pleurisy have been emphasized times innumerable. Let us add chest injury to the pleurisy. There are few internists who have not placed the lesion in the peritoneal cavity, and few surgeons who have not operated in such cases for appendicitis or other acute abdominal condition—all of which means that the differential diagnosis is often extremely difficult.

It is hoped that the simple sign here described may be of value to some in such cases when rigidity is present. So far as I have been able to learn, it has not been mentioned in the literature. When the lesion is intrathoracic, the rigidity of the abdominal muscles momentarily relaxes at the end of expiration. This is typical, and is not present regularly at any other period of the respiratory excursion. When the lesion is intraperitoneal, the rigidity is usually constant; but, if intermittent, is not

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