Intrathoracic aneurysm / by F. de Havilland Hall.

  • Hall, Francis de Havilland.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Intrathoracic aneurysm / by F. de Havilland Hall. Source: Wellcome Collection.

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

    13/98 (page 9)
    diagnosis can rarely be made with certainty. It is almost impossible to single out from among the symptoms which may be accounted for by the many attendant lesions, those peculiar to an aneurism rarely exceeding the size of a filbert, and buried in the base of the heart. A diastolic murmur is frequently met with in these cases, but it is often inaudible, and comes and goes without any definite reason. In my case it is quite certain that there was no diastolic murmur while he was attending as an out- patient, but soon after his admission a loud diastolic murmur was audible, in the production of which this aneurysm took, I believe, a leading part. This view is in agreement with that given in Fagge and Pye-Smith: '' If the aneurism forms a pouch in the sinuses of Valsalva the valves become involved, their closure may be prevented, a diastolic bruit be produced, and all the other signs and symptoms dependent upon regurgitation occur. These may, indeed, be the only symptoms, and none exist indicative of the presence of an aneurism. The sac neyer grows to any great size, and usually bursts into the pericardium and causes instant death. A symptom occasionally noticed is a single or double murmur at the pulmonary orifice ; this is met with when the aneurysm develops in the direction of the pulmonary open- ing, and thus by increase in size distorting that orifice. A very unusual, indeed I might almost say unique, point of projection of an aneurysm is that recorded by Dr. Churton.^' During life the swelling extended from the second to the fourth rib and from the mid-axilla to the nipple line, so that the aneurysm projected into the right axilla. At the necropsy the aneurysm was found to lie wholly in front of the lung and to have compressed the lung. An aneurysm of the descending portion of the arch may appear externally, to the left of the spinal column, as in a case reported by Dr. John Brunton.i* The swelling was noticed between the vertebral border of the left scapula and the spinal column, the scapula being pushed outwards. Death occurred by rupture into the left pleural cavity, and at the necropsy a large aneurysm was found communicating with the posterior wall of the aorta.