On a case of death from hæmorrhage into the pericardium, as a result of rupture of one of three true and circumscribed aneurysms of the coronary artery of the heart : with observations on aneurysm or aneurysmal dilatation as a result of embolism or thrombosis.

  • Ogle, John W. (John William), 1824-1905.
Date:
[cbetween 1800 and 1899?]
Catalogue details

Licence: Public Domain Mark

Credit: On a case of death from hæmorrhage into the pericardium, as a result of rupture of one of three true and circumscribed aneurysms of the coronary artery of the heart : with observations on aneurysm or aneurysmal dilatation as a result of embolism or thrombosis. 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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    distinguishable from neighbouring parts. Again, to the left of the others (towards the right edge of the heart), and on a higher level than the first pouch described, was a third pouch, of about the size of a small cob-nut, almost quite empty, and with thin walls, which at one spot were perforated by a hole scarcely admitting the passage of a pig's bristle. Through this aperture the blood, which was found to fill and distend the pericardium, had found its way. This aneurysmal sac freely communicated with a descending branch of the right coronary artery, which was quite unobstructed, and in all respects healthy. Abdomen. The liver was hard and congested ; the spleen healthy. The right kidney was coarse and congested, and its capsule infiltrated with blood. At its base a large mass of recently extravasated blood was met with in its substance ; and on examining it at one extremity, this mass was found to contain a cavity lined by a distinct and firm membrane, of about the size of a small pea, and containing a quantity of coagulated blood of the same character as the general mass sur- rounding it. This could be picked out of the cavity entire, leaving the membrane tolerably smooth. On trying by dissection to find a com- munication between this small sac or cavity and some arterial branch, it appeared as if such an one had existed, but it could not be altoge- ther very satisfactorily made out. In the same kidney were also two old-standing blocks or masses of fibrinous deposit. The left kidney was quite natural; the large arteries of both kidneys were natural. The right arm was very swollen on its inner side and towards the elbow, and the surface was red and darkish in colour at this part. On dividing the integuments and muscles in this region, much blood was found to have been extravasated into the muscular structure and intermuscular tissue. It proved impossible to find out exactly the source of the haemorrhage ; but two of the minute muscular branches from the brachial artery, low down in the arm, were found to have aneurysmal pouches connected with them, quite full of firmish coagulum. These sacs were perfectly entire, and one of them was in close py^oximity with the median nerve. It appeared most likely that some other aneurysm had existed, which, having given way, had allowed of the haemorrhage amidst the tissues, &c. The small branches having the aneurysms con- nected with them, as also the main brachial artery, were quite free from any disease. Coinments.—Before proceeding to the pathology of the above case, I will make a few remarks upon certain points of clmical interest which it contams. On reviewing the cir- cumstances of this case there can be no doubt, I think, that death eventually resulted from the giving way of the aneurysm of the coronary artery into the pericardium, which was other- wise healthy. The walls of the aneurysm had for some time been yielding and getting thinner, and at last the small aper- ture before described was produced. The oozing of blood