Case : a large pedunculated thrombus hanging from the wall of the left auricle, associated with mitral stenosis / by John Hay.

  • Hay, John, 1873-1959.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Case : a large pedunculated thrombus hanging from the wall of the left auricle, associated with mitral stenosis / by John Hay. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The praecordial dulness is greatly increased, measuring 11 inches in the transverse diameter {vide Chart). On auscultating, a rough, grating, harsh blowing systolic murmur, with squeaks and wheezings associated with it, is heard all over the front of the chest. This murmur is loudest over the apex beat, and is conducted into the axilla. It is also rather loud over the second left space. No first sound is audible. The second sound is only very faintly heard at the apex of the heart, but is loud and clear over the pulmonary valves (for area of good second sound, vide Chart). No systolic murmur in neck or trachea. Marked systolic pulsation in veins of neck. The pulse is quite regular in time and force, 120 to the minute; small in volume, and tension not well maintained. Breathing rather difficult, forty respirations per minute. Expectoration frothy, purulent, viscid; expelled with difficulty. Liver much enlarged, extending down to umbilicus. The examination of the chest showed the presence of fluid at the right base. There were also signs of oedema of the lungs, especially on the right side. A diagnosis was then made of mitral stenosis and regurgita- tion, together with free tricuspid regurgitation; and, taking into consideration the evident great dilatation and hypertrophy of the right auricle, it was suspected that there might also be some stenosis of the tricuspid orifice. The question of fluid in the pericardial sac was also dis- cussed; but as the presystolic pulsation and the apex beat were both well to the outer limits of the dulness, it was thought that there was probably no great pericardial effusion. Under treatment she improved, and on the 26th March xvii. oz. of clear serous fluid were withdrawn from the right pleural cavity, after which her breathing seemed easier. In the evening of the same day she complained of pain all over her body, and half an hour later suddenly died.
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