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Previous Volume 351:2881 December 30, 2004 Number 27 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: Wang and Bashore's statement that physical examination provided "little guidance" in the case described in their Clinical Problem-Solving article (Sept. 2 issue)¹ is challenging in its omissions. Admittedly, the patient's extreme obesity made physical examination difficult. Nevertheless, a finding of pulsus paradoxus may have suggested that pericardial constriction was present, as later proved to be the case. Inspecting the neck while the patient is sitting or standing sometimes reveals the jugular column, which may otherwise be hidden by other neck structures or by the ears when the elevation in venous pressure is extreme. Even in a patient . . . [Full Text of this Article]

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