Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
[1852]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie. Source: Wellcome Collection.

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    gress of the tumour should have been towards the cavity of the chest, and not towards the surface below the clavicle, or downwards into the loose cellular tissue of the axilla. Such an extension of an axillary aneurism is quite unusual, and, I think, highly improbable. In the next place, the interior of the cavity presented none of the appearances which are found in the cavity of a spontaneous aneurism, which had undergone suppuration. There were no broken-down masses of fibrin, nor appearance of concentric laminae, which are invariably present in such circumstances. On the con¬ trary, there were, as in Mr Liston’s case, only patches of fibrinous deposition adhering to the sac at one or two points. Further, the opening of communication between the artery and the cavity presented none of the appearances of the opening of a spontaneous aneurism. It was not a thickened everted opening, with adherent fibrine, nor was there the slighest extension of the external or inner coats over the walls of the sac. On the con¬ trary, the edges of the opening were soft and pulpy, and the per¬ foration of the coats was abrupt and defined. Lastly, spontaneous aneurism does not often occur without more or less general arterial disease; but in this case, with the exception of the right axillary artery, the arterial system was perfectly healthy throughout. I have said that it had been suggested that the disease may have been a simple abscess, and that the pulsation may have been com¬ municated from the neighbouring artery. In answer to this supposition, it may be stated, in the first place, that the signs of aneurism were most unequivocal. One of the signs, however, in this case was not to be depended on, viz., the emptying of the tumour by pressure made on its surface. Sup¬ posing the disease to have been only abscess, the pressure would have caused the matter to recede into the chest through the inter¬ costal opening. The removal of the pressure, however, was in¬ stantly followed by the peculiar expanding pulsation characteristic of aneurism, and was accompanied by a loud bruit de soufflet. But one well-marked symptom was present, which alone pre¬ cludes the idea of the disease being a simple abscess. Pressure on the subclavian artery over the clavicle not only arrested the pul¬ sation of the tumour, it produced remarkable subsidence of the swelling,—so much so, that Mr Syme remarked, whilst compressing the subclavian artery alone with the finger, that “ the tumour was gone.” This could not have occurred had the disease been a simple abscess. The tumour instantly refilled on removal of the pressure on the artery. Lastly, if the tumour was only an abscess, the ulcerated opening of the artery must have taken place after the operation, at a time when the artery was collapsed and empty, and obliterated to within two inches of the opening. This view of the matter is so extremely improbable, that I need scarcely say more to refute this opinion. Were further proof
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