Intrathoracic aneurysm / by F. de Havilland Hall.

  • Hall, Francis de Havilland.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Intrathoracic aneurysm / by F. de Havilland Hall. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    12/98 (page 8)
    production of aneurysmal dilatations, as the frequency of the disease diminishes as the distance from the heart increases. Aneurysms of the ascending part of the arch of the aorta, which come to the surface and give rise to a tumour, almost invariably arise from the right or convex side of the vessel, and tend to enlarge towards the right. Dr. Gee states that he has found only one reference to a state of things contrary to that mentioned above as being the rule ; and he quotes Oppolzer^ when speaking of aneurysm of the ascending aorta as follows : That as to the situation of the tumour to the right of the sternum, this is undoubtedly the rule in the majority of instances, inasmuch as the aneurysms arise like- wise, as a rule, from the convex side of the arch. But in exceptional cases they spring not from the convex but from the concave wall of the aorta, and then the said tumour is found, not on the right, but on the left side of the sternum. Dr. Gee'' has himself recorded a case in which a low, rounded, smooth tumour was seen stretching from the second to the fifth ribs on the left side between the sternum and the nipple line. Systolic pulsation was palpable, and a blowing systolic murmur and a weak second sound were audible over the tumour. Dr. Gee considered it probable that the signs were produced by an aneurysm of the pulmonary artery, but at the necropsy the aneurysmal sac was found to be formed by dilatation of the whole of the ascending part of the arch of the aorta. The case I have just narrated illustrates the view that we are not justified in inferring the place of origin of an aneurysm from the place at which it appears on the chest. As another example of this difficulty I may point out that an aneurysm arising from the descending portion of the aorta has, nevertheless, come to the surface against the upper ribs. Of aneurysms at the sinuses of the aorta I have had but little experience. I recorded a case of a patient with four distinct aneurysms in the arch of the aorta, one of which was of this nature. Just above the aortic valve, correspond- ing to the sinus of Valsalva, was an aneurysmal cavity of the size of a small Tangerine orange. The valve allowed slight regurgitation. In his article on Aneurism at the Sinuses of the Aorta Sir Richard Douglas Powell remarked: The