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.

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    to ask him to call again, when I recognised that he was hoarse. A laryngoscopic examination showed the left vocal cord in the cadaveric position, and a pulsation under the left clavicle convinced me of the presence of an aneurysm. Knowing that he was a locum-tenent out of work I advised his admission into Westminster Hospital. He came in two days later, and on the night of admission, while talking to the nurse, he was seized with acute pain in the chest and died within a few seconds. The necropsy showed rupture of a large aneurysm into the pericardium, and yet prior to his visit to me the patient was doing his ordinary work quite unconscious that he was seriously ill. The fatal termination of the second case came to me as a shock at the time, but subsequent consideration has con- vinced me that the diagnosis of an aneurysm in this particular case was almost impossible. I doubt whether even an X ray examination would have revealed the true condition of affairs. A stout-built, healthy-looking man, aged 46, a solicitor, consulted me on account of a swollen condition of his face. He stated that the swelling was first noticed the morning following a heavy dinner, the eyelids being especially affe^ted. Physical examination of the chest revealed nothing amiss. The urine contained a trace of albumin. From the patient's ap]3earance and the account he gave of himself I came to'the conclusion that he lived too well and that his kidneys were affected. He paid me a second visit five days later. I heard nothing more of the patient until 11 days after his last visit, when I received a telephone message from the coroner to say that while playing at bridge the patient suddenly fell off his chair and expired at once. Death was found to be due to the rupture into the pericardial cavity of an aneurysm seated 2 inches above the aortic valve, the pericardium being distended with blood clot. A puffy or swollen condition of the face is not unfrequently present in cases of aortic aneurysm, but apart from this symptom there was nothing to direct my attention to the state of the patient's aorta. The rupture into the pericardial cavity of an aneurysm, originating from that portion of the aorta covered by the