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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    having a small cavity, and weighing 16 oz. The coagulum was partially separated at the oritice of the aneurism, and a thick, dark-coloured clot of blood lay between it and the sac-wall. Posteriorly a saccule existed, with dense surrounding tissue the size of a filbert, and in contact with the trachea. The upper two-thirds of the sternum were wanting. Both the clavicles rested on the coagulum, and had their periosteum separated from tlieir sternal ends, with recently effused blood interposed, continuous with the soft clot that lined the sac. The heart was hypertrophied. No lesion of the valves. The vagus and recurrent nerves were free from the tumour. Both lungs were slightly emphysematous. With reference to the want of agreement between the reported diastolic murmur in this case, and the apparently normal state of the sigmoid valves, I can offer no explanation, nor shall I argue as to its sigmoid or aneurismal scat. In evidence of the care taken to determine its nature, I quote the following notes from the re¬ cord of the case, dated 8th January 1852 :—u At the apex cordis the second sound is converted into a prolonged bellows murmur. Over a spot on the sternum, on the level of the third intercostal spaces, and corresponding to the lower boundary of the morbid tini¬ ness of percussion, both heart sounds are free of murmur.” Upwards, on the tumour, no bellows sound existed. On the 12th July 1850, it was noted,—u The murmur reported with the second sound at the apex is doubtful.” In the existing state of our knowledge, the supposition is more than justifiable that this diastolic murmur, appearing and disappear¬ ing as it did, originated in the aneurismal orifice; but if the fibrin¬ ous mass contained in the sac prevented it being heard on the tumour, it is difficult to explain how it could reach the apex cordis. Further, the aneurismal diastolic murmur is described by authors as being peculiarly a faint murmur, and therefore liable to be over¬ looked. And there is reason to suspect that the murmur of aortic regurgitation in such cases as the following, might be confounded with it:— Case YIII.—Saccular Aneurism of the Ascending Aorta; Second Cardiac Sound cavernous, with Bellows Murmur; Insufficiency of the Aortic Valves; Hypertrophy of the Heart. William Scott, set. 53, stonemason, admitted into the Royal Infirmary under my care. A man of robust frame, but spare, and suffering from dyspnoea and palpitation. History.—lie had been under treatment for some weeks previously to ad¬ mission, with relief to severe bronchitis. lie had been unfit for work for a month, but had experienced occasional distress for twelve months. Physical Signs.—Coverings of the chest spare, with prsecordial fulness and diffused cardiac pulsation ; that of the apex was perceptible in the fifth space to the left of the usual situation. In the second right intercostal space, close to the sternum, there was very slight visible pulsation, synchronous with the cardiac beat. There was permanent fulness of the external jugular vein, and visible irregular pulsation of the internal. Radial pulses equal, quick in action, not decidedly diastolic, visible. Prsecordial space dull on percussion, extended vertically from the third left cartilage five inches downwards, and transversely from a line an inch left of the mesial line, four inches leftwards. There was