PSEUDO-PERICARDITIS. 391 



disease. This refers to accidents by which the foreign body closely 

 approaches, without actually touching, the pericardium, the lung or the 

 pleural sacs, but in which it causes purulent collections which displace 

 the pericardium, indirectly compress the heart, and finally cause symp- 

 toms of an apparently pericardial character. 



Causation. During the development of pericarditis the foreign body 

 perforates the reticulum and diaphragm, passing along the middle line 

 of the body, without which it would not come in contact with the peri- 

 cardium. If the perforation, however, occurs to the right or left of the 

 median plane, the foreign body moves forward just as easily, but it 

 misses the pericardium and passes either into the lung, where it causes 

 fatal pneumonia ; or the pleura, where either it sets up septic pleurisy 

 in the subpleural connective tissue or produces an abscess. 



The abscess is generally lateral, situated in the right subpleural 

 region, or it may develop below the pericardium. These are the two 

 varieties of pseudo-pericarditis seen by Moussu. 



There is, however, a third variety, which might be called " parasitic 

 pseudo-pericarditis." It is extremely rare, and Moussu has only seen 

 one case. It was due to the presence of an enormous hydatid cyst of the 

 right lung as large as a man's head, which was situated towards the 

 mediastinal plane of the lung and pressed on the supero-posterior sur- 

 face of the heart and pericardium. In consequence of the permanent 

 downward pressure which it exercised it interfered seriously with the 

 heart's action and caused symptoms of pseudo-pericarditis. 



Symptoms. The general and external symptoms are those of peri- 

 carditis — viz., dulness, diminution in appetite, irregular rumination, 

 wasting, oedema of the dewlap, distension of the jugulars, marked 

 venous pulse, great anxiety and dyspnoea when the patients are forced 

 to move, etc. 



But the cardiac symptoms differ notably, and moreover vary, accord- 

 ing to the nature of the lesions. Speaking generally percussion reveals 

 complete dulness on one or both sides, and auscultation always indicates 

 the absence of sounds due to extravasated fluid in the pericardial sac. 



When the abscess is situated below the pericardium, a condition 

 difficult to diagnose, the dulness seldom extends very high on either 

 side of the chest, and the sounds heard over the cardiac area, while 

 much weaker than usual, are audible above the normal points. 



An abscess developing beneath the pleura on one side displaces the 

 heart in the opposite direction. The cardiac beat is weakened by the 

 compression, but, nevertheless, transmits an impulse to the purulent 

 fluid, which in its turn conveys it outwards through the intercostal 

 spaces in the form of movements corresponding in rhythm with the 

 beating of the heart, so that at first glance one might imagine an 



