Case of mixed aneurism of aortic arch simulating aneurism of left carotid : with remarks / by James G. Wilson.

  • Wilson, James G.
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: Case of mixed aneurism of aortic arch simulating aneurism of left carotid : with remarks / by James G. Wilson. Source: Wellcome Collection.

    10/16 (page 10)
    spiciiously in tlie space behind and above the root of the left lung, and completely filling the space forwards and upwards to¬ wards the clavicle and the sternum in front. The left subclavian and carotid arteries were dissected from their origins at the arch upwards through the grooves on the posterior aspect of the tumour. The former vessel appeared unchanged, the carotid w’-as obliterated (from ligature) downwards to its origin from the arch. The left subclavian vein was compressed by the upper and posterior part of the tumour. The pneumogastric nerve of the same side was flattened out, and firmly imbedded in the substance of the tumour; so also was the phrenic nerve towards its outer and anterior aspect, along with the internal mammary artery. The aneurismal sac was observed to proceed from the ascending portion and arch of the aorta, at its anterior aspect, so as to involve the arteria innominata, and the origins of the other large vessels in its dilatation, and holding the relations with those parts which I have already described. TTe parietes of the sac were of a fibro-cartilaginous density, and appeared to be greatly thickened at the expense of the condensed surrounding areolar tissue, more especially behind and laterally. Through the medium of this substance, as well as through new formations, the sac was firmly coherent with the following surrounding textures:— 1st, Pleura of left side. 2d, Periosteum on inferior surface of clavicle and sternum. 3d, With the left subclavian vein. 4th, With the condensed tubular prolongations of fibrous tissue, re¬ ceived from the pericardium. 5th, Enlarged lymphatic glands. The coalescence of all these parts with the sac of the aneurism was marked by a great increase of vascularity, and, in some parts, by destruction of the texture of the walls of the sac itself, so that the aneurism, originally circumscribed by the arterial tissue, strengthened by coalescence with surrounding parts, had at last given way, and permitted the blood to diffuse itself among sur¬ rounding textures. The wasting of the parietes of the sac was observed to have taken place by slow degrees in two places: first, towards the sternal end of the clavicle ; and this change had been accompanied by the disappearance of the periosteum between the sac and sternal extremity of the clavicle, and also of the capsular ligament of the sterno-clavicular articulation, so that the cavity of that joint had been made one with the aneurism. In this direction, the contents of the sac had been still further diffused into the left subclavian triangular space, passing up by the pleura of that side. The sloughy condition of this space may be attributed partly to the pressure of the sac upwards, and enlargement of the lym¬ phatic glands, but more especially by external openings made through the skin, and the swollen parts penetrating the superficial vascular canals (venous and lymphatic), promoting thereby the destruction of parts from without inwards, and by permitting the