Quiz 26: Clinical Sign

Questions:

1) Sulcus indicated by the dashed line in the chest of this infant is named after a physician. What name is it.

2)      Provide differential diagnoses for this clinical sign (including at least one relevant to cardiology).

Answers:

1) Harrison sulcus

2)      Diffierential diagnosis: (i) Rickets, (ii) Asthma and (iii) Congenital heart disease with significant L-R shunt. 

Discussion:
The line of indrawing approximately corresponds to insertion of diaphragm and is thought to be caused by repeated, forceful diaphragmatic pull during infancy when the bony cage is relatively soft. This occurs with any condition associated with chest retractions (Asthma & L-R shunt lesions in the heart). In rickets, normal pull of the diaphragm on the softer the bony cage (softer, due to rickets) is considered the reason.

Unnati sent this article on Harrison’s groove: Naish J & Wallis HRE. The significance of Harrison’s grooves. Br Med J 1948;1:541-44. This article has a discussion on mechanism of causation of this groove (or sulcus). It questions the theory of diaphragmatic pull in the early part. But, later part of the discussion provides evidence from work of Herlitz (1945) that supports this theory.