A case of pulmonary arterial reflux / by Sir Dyce Duckworth.

  • Duckworth Dyce, Sir, 1840-1928.
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: A case of pulmonary arterial reflux / by Sir Dyce Duckworth. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    But little improvement followed on treatment adapted to his general condition. Digitalis was hardly of any avail. On January 25 the following note was made as to the heart- signs : A diastolic thrill at the apex. First sound heard at beginning but passing at once into a murmur which is audible in axilla and behind. Systolic murmur heard over ensiform cartilage. The pulmonary second sound is not heard. Dia- stolic murmur as before. Some pulsation of jugulars. An attack of gout occurred at this time in left foot and great toe- joint. Early in February signs of increasing cardiac dilatation appeared with oedema of the lungs. Very little urine was passed. Cough was troublesome with copious greenish puru- lent expectoration, void of blood. The pulse was a little over 100, and respirations 30 in the minute. On February 16 the cardiac apex was found a little further out in fifth space. The diastolic murmur was less loud. Pulmonary second sound not heard. Jugulars fuller. Ana- sarca increasing. There supervened increasing cardiac debility and dropsy, with mental clouding, and death occurred on March 6. At the necropsy the lungs were found emphysematous and oedematous. Pericardium natural. Heart very large with much dilatation, especially of right ventricle. The mitral and tricuspid orifices were dilated, the aortic valves natural. The pulmonary valves were two in number, one large one with much thickened edges, and one smaller with similarly thickened edges. Between the two was a vacant space show- ing some slight roughening at the site where a third valve should lie. Below this was a thin-walled aneurismal pouch, capacious enough to hold a large hazel nut. Septum of ven- tricles complete. The liver was nutmeg.'' Spleen a little enlarged, void of infarcts. Kidneys hard, but otherwise apparently natural. The heart is preserved in the hospital museum; the condi- tion of the valves is shown in Plate III. It is possible that there was congenital disease of the pulmonary sigmoid valves in this case. The appearances rather indicated the previous existence of an incomplete valve at the vacant part of the pulmonary ring. There had probably been regurgitation throughout life, without any symptoms manifesting themselves till the cardiac wall failed in its nutrition. Judging by the light of the physical signs it seems hardly creditable that the diagnosis was not made with certainty.