Symptoms And Signs /Obsolete , Evergreen And New


O P Kapoor
Ex. Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

As a medical student we were taught that the tracheal tug is a diagnostic sign for the aneurysm of the arch of the aorta. This sign is very difficult to learn and to elicit. One has to stand behind the patient, over stretch his neck backwards, grip the cricoid cartilage of the trachea and then feel by palpation whether the trachea is pulled down with every beat of the heart.

The most common cause of the above aneurysm was cardiovascular syphilis which has more or less disappeared for the last 30 years. In my opinion, this sign now should be tagged to the patient of severe emphysema and COPD. In these patients you do not have to do all the tricks described above. All you have to do is to look at the front of the neck of the patient who is invariably breathless. You may ask him to slightly stretch the neck backwards like examining the thyroid gland (often not necessary).

You will now see that with every inspiration Adam’s apple (trachea) moves up and down. This is an excellent sign to diagnose emphysema.

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