Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas.

  • Douglas, A. Halliday (Andrew Halliday), 1819-1908.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Substernal aneurism : cases and observations on its diagnosis, and relation to disease of the heart / by A. Halliday Douglas. Source: Wellcome Collection.

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    December she became more feeble and languid than previously, and on the morning of the 28th she became suddenly faint. She rallied, but died in the course of an hour or two. Post-mortem Examination disclosed a large clot of blood in the left pleura. There were firm cellular adhesions of the upper lobe of the lung posteriorly. The heart and its valves were healthy, except glistening white spots on the pericardial surface. The upper part of the left lung was displaced by an aneurismal tumour considerably larger than the list; and the compressed upper lobe of the lung was closely adherent to the outer and back surface of the tumour. Rupture of the sac by a very small slit, had taken place at the outer and lower part of the tumour, where screened by adherent lung. On the left side, the par vagum (fig. 2, d) was found incorporated with the wall of the sac, at its upper part, so that it could scarcely be traced ; it was displaced outwards, and was lost where the lung adhered to the sac. The recurrent nerve of this side was found in the first part of its upward course, in firm contact with the poste¬ rior wall of the aneurismal sac. Tracing it downwards, it was found to emergo from the sac-wall, but could not be traced to its connexion with the vagus nerve. At the upper part, the phrenic nerve (fig. 2, e) on this side was found entering the sac-wall, in which its fibres could be traced imperfectly; it emerged at the lower and anterior part of the sac, whence it pursued its course along the peri¬ cardium. The left subclavian artery (fig. 2, b) Avas compressed behind and Avithin the upper part of the tumour. On laying open the sac of the aneurism, it Avas found nearly empty, forming one uniform sac, lined throughout by an unor¬ ganized fibrinous pellicle, and communicating avith the artery by a largo orifice comprehending the anterior wall of nearly the Avhole transverse arch, and about two-thirds of the circumference of the vessel ; thus including the openings of the innominate and left carotid arteries. Tho aperture of the left subclavian artery Avas excluded from the sac by the projecting marginal fold of tho orifice. I have not met with any case in which the cavernous character of the second sound over the tumour was more marked, and in which the sounds at the base of the heart preserved their natural quality. The same condition of the second sound was very marked in the following case. Case V.—Saccular Aneurism of the Arch of the Aorta, at its termination; Cavernous intensified Second Sound over Tumour—at the Heart, both sounds normal; Death from Effects of Fatigue. James Henderson, set. 30, flax-spinner; admitted under my care in tho Royal Infirmary, 12th June 1845. A well-developed man, suffering from cough Avith expectoration, dyspnoea, and hoarseness, accompanied by pain in the left upper front of chest, extending to left shoulder. Physical Signs.—There Avas slight prominence of left front, and an obscure impulse in this subclavian space, distinct from tho impulse of the heart. In the same situation, there was dull percussion with tenderness. The praicordial dull space was of the natural extent. The cardiac sounds Avero normal in tho region of the heart; but upwards, in the subclavian space, tho first sound was superseded by a sharp bellows murmur ; tho second sound Avas intensified and liollow-toned, presenting the characteristic metallic cavernous ring. The left internal jugular vein was permanently distended ; tho left radial pulse was small; and the respiratory murmur Avas impaired in the left lung. History.—lie stated that the existing symptoms had arisen within ten Avecks, and that his illness originated in the effects of exposure to cold, with rigors, headache, oppression of the chest, cough, with expectoration and hoarseness, lie had been relieved by active treatment, but the hoarseness had undergone no improvement.