Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
[1852]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie. Source: Wellcome Collection.

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    and oesophagus were included within the incisions; the sternum divided longitudinally, and the three first ribs removed in connec¬ tion with the parts. In thus exposing the right side of the cavity of the chest, it was found that the lung was universally attached to the thoracic walls by old and firm adhesions, except from within a very short way from its apex to the level of the fourth rib. This space was con¬ verted into an abscess, which extended, about the same level, for¬ wards as far as the costal cartilages, and backwards to within two inches of the angles of the second and third rib. The second rib lay bare, and at points eroded, in the cavity of this abscess for about four inches, as well as a small portion of the lower border of the first rib. The quantity of pus contained in this abscess appeared to be about four or five ounces. The abscess appeared to have had its origin between the walls of the thorax and costal pleura. This was thought probable, from the ribs and intercostal muscles being completely separated from the membrane, whilst the surface of the lung was still covered by a dense and thickened layer, formed apparently by the adherent and thickened costal and pulmonary pleura. The tissue of both lungs was healthy throughout, except the upper part of the right lung, which did not crepitate on pressure quite so freely as other parts of the lung. The bronchi and their ramifications were universally slightly congested, and contained a considerable quantity of mucus. The heart was in all respects healthy, and no trace of disease could be detected in any part of the arterial system. The parts concerned in the local disease were examined, by first exposing the wall of the cyst, and laying bare the artery upwards from beneath the origin of the large branches in the axilla. The cavity of the sac was then laid open by an incision through its an¬ terior wall, in a line with the course of the artery. On doing this, about an ounce of pus escaped, mixed with one or two small recent coagula ; and so little did the interior of the cavity present of the appearance of an aneurismal sac, that I was at once impressed with the idea that no aneurism existed, but that an error in diagnosis had been made; that the disease was simply an abscess, which had received a pulsatory movement from its contact with the artery. On reflecting, however, for a moment on the unequivocal nature of the symptoms, and on the speedy and great diminution of the size of the tumour after the application of the ligature, I was satisfied that this could not be the case. On washing gently the inner surface of the cavity, it was seen that the greater part of its surface presented the loose flocculent appearance of an abscess; that a small portion of the lower border of the first, and the second rib to the extent of between three and four inches, were bare, and at some points rough, from destruction of their lamellated surface, and that a large communication existed in the second intercostal space between the cavity and the abscess