Remarks on osteo-aneurism : with a case involving the condyles of the left femur / by J.M. Carnochan.

  • Carnochan, J. M. (John Murray), 1817-1887
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on osteo-aneurism : with a case involving the condyles of the left femur / by J.M. Carnochan. Source: Wellcome Collection.

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    It is to Scarpa that we are chiefly indebted for the facts thus far known in relation to the morbid anatomy of Osteo-aneurismatic tu¬ mors. Whatever may be the elementary lesion of tissue in this dis¬ ease; whether it be of a character analogous to the erectile tumor of the soft tissues, or whether the incipient change of structure be de¬ pendant upon a degeneration and dilatation of the coats of the smaller arterial tubes by which the spongy portions of the bone are nourished, it is to a certain degree established that these tumors of bone invari¬ ably originate in the cancellated structure of the osseous system, and most commonly in the tibia, at its upper extremity, and next, in t.he condyles of the femur. The diplbe of the flat bones of the cranium would also seem, at times., to .afford a .nidus for the development of the pulsative osseous tumor, and even the cancellous struc¬ ture of the scapula has been found to be the original seat of the disease. The disease once developed, a cavity is formed in the interior of the bone, at the expense of the cancellous structure, and this appa¬ rent loss of substance continues as the disease advances, until the ex¬ tremity of the bone becomes enlarged and expanded into a laminated shell. This bony cyst, presenting on its external surface, upon manu¬ al examination, irregularities and depressions, will become so thin as to be flexible and elastic under pressure, affording to the fingers a sensation of crackling or crepitus. As the tumor enlarges, the osseous wall may be destroyed, at certain points, by absorption,; the interven¬ ing spaces, previously occupied by the lamellated bone, being then replaced by thickened periosteum and the super-imposed tissues. In some instances, the destruction of the cancelli is so great that a trifling force will be sufficient to separate the entire articular extremity of the bone from its shaft This was the case with the condyles of the femur represented in the drawing, [vide plate No. I.] On the external surface of the sac, the periosteum is found thickened, and the articular arteries .are seen enlarged and creeping over the tumor; some of them perfo¬ rating its wall. The inner surface is irregular, unequal and rough, presenting at points, where the arteries have been injected, the open orifices of the arterial vessels. The interior of the sac, as related by Scarpa, presented in one instance clots of blood and strata of coagu lated fibrin, similar in appearance to the contents of a sac of a true