Four cases illustrative of difficulties in the diagnosis of aneurysm of the aorta / by Geo. S. Middleton, M.A., M.D., F.F.P.S., Physician to the Royal Infirmary and to the Royal Hospital for Sick Children.

  • Middleton, George S.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: Four cases illustrative of difficulties in the diagnosis of aneurysm of the aorta / by Geo. S. Middleton, M.A., M.D., F.F.P.S., Physician to the Royal Infirmary and to the Royal Hospital for Sick Children. Source: Wellcome Collection.

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

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    There was no difference in the pupils or in the pulses, but his cough was somewhat laryngeal, and he had some dysphagia. On 9th November a degree of dulness and increased resist- ance were made out on the right side of the abdomen, extending downwards from the hepatic dulness. During the time he was under observation he had numerous attacks of dyspnoea, and he became quite unable to swallow anything. His temperature, 97 on admission, rose to 100° on the day of his death. He was never in a condition in which he could be subjected to much examination. In this case the diagnosis naturally could not be a definite one, but it was clear that there was something abnormal both in the thorax and in the abdomen. At the post-mortem examination, “ on opening the abdomen, a small but quite distinct trace of blood was found covering the loops of intestine, particularly those lying in the pelvis. The lower part of the omentum was covered with a thin layer of blood. On opening the chest, the left pleural cavity was found to contain 14 or 15 ounces of thin blood. On turning forward the left lung, a bulging, fluctuant, elongated swelling was found in the posterior mediastinum, extending from the level of the sterno-claviculur articulation to the diaphragm, and occupying the region of the descending aorta,” This swelling was found to be a large aneurysm, which “ had evidently become diffused into the tissues of the posterior mediastinum without actually rupturing the pleura or the pericardium. The blood had thus made its way through the posterior openings of the diaphragm into the region of the abdomen, infiltrating the tissues behind the peritoneum, and also extending for some distance on to the anterior wall of the stomach. This infiltration of blood, which lay immediately behind the cardiac end of the stomach, was so abundant as to at first suggest the possibility of a second aneurysm of the abdominal aorta, but that part of the vessel, beyond very slight atheroma, presented no abnormality throughout its whole extent. It was clear that the traces of haemorrhage met with in other parts of the peritoneum had originated here. The aneurysmal dilatation ceased abruptly at the