PEEICAKDITIS. 



245 



in either of these positions may, by rupture, give rise to intraperi- 

 cardial haemorrhage. Since the oesophagus is in intimate relation 

 with the posterior part of the sinus obliquus, the pericardium 

 may be perforated by foreign bodies in, or opened by malignant 

 disease of, this tube. Disease of the ribs, sternum or vertebras may 

 invade the sac by continuity, and abscesses in the heart wall 

 may rupture through the visceral layer. Very rarely gastric 



int. mam. 



sternum 



superfic. 

 pericard. 



reflect, 

 of pleura 



diaph 



transv. 



sup. epigastr 



skin and 

 superf. fascia 



nipple 

 ect. maj. 

 pect. min. 

 ext. intercost. 

 int. intercost. 

 triang. sterni 

 pleura 



over apex 

 of heart 



ext. ob. 



reflect, 

 of pleura 



rect. ab. 



FIG. 24. THE RELATIONSHIPS OF THE PERICARDIUM AND PLEURA TO THE 



THORACIC WALL IN THE APICAL REGION. (After Froh-se, Hughes 



and Keith.) 



ulcers have been known to open into the pericardium, this 

 being rendered possible by the projection of the lower part of 

 the sac beyond the anterior margin of the left lobe of the liver, 

 so that only the diaphragm intervenes between it and the 

 stomach. In some instances the pericardium bears a similar 

 relation to the transverse colon near the splenic flexure. 

 Subphrenic abscesses may open into the lower part of the sac. 



