Case of mixed aneurism of aortic arch, simulating aneurism of left carotid, with remarks / by James G. Wilson.

  • Wilson, James G.
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: Case of mixed aneurism of aortic arch, simulating aneurism of left carotid, with remarks / by James G. Wilson. Source: Wellcome Collection.

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

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    The third opening was situated in the upper third of neck, in the course of the carotid artery, and communicated with the spongy texture of the interior of that vessel, which had been obliterated by a ligature twenty weeks previous to death. This opening passed through a superficial jugular vein, which contained a coa- gulum of softened and decomposing blood, reaching downwards as far as the slough before mentioned. The textures in this region were much condensed and altered, by an increased amount of binding tissue, and by the sloughing of the softer parts. The lymphatic glands were also considerably enlarged, more especially in the subclavian spaces. Thorax.—On opening the cavity of the thorax, the lungs were prevented from collapsing by numerous bands of fine fibres, binding their surfaces to the costal pleurae on both sides; but the whole of the right lung, and the two lower thirds of the left lung, appeared to possess all the qualities of healthy pulmo- nary tissue. Firm adhesions of the pericardium to the sternum required also to be cut through before raising that bone; and as the density of adhesion increased between the manubrium and the parts immediately below it, the body of the bone was removed at this part. A small amount of pus-like exudation lay upon the surface of the exposed space. The pericardium, pleura of the left side, and the remains of the thymus gland, were firmly adherent to each other. On opening the cavity of the peri- cardium (which appeared more than usually distended), an increased amount of fluid escaped from it; and that portion of the inner surface of the membrane which is reflected from the aorta, the left pulmonary artery, and bronchial vessels, presented a marked increase in vascularity, approaching to an inflammatory state. As the parts immediately surrounding the left sterno- clavicular articulation, extending as far downwards as the origins of the great vessels, and a considerable portion of the upper lobe of the left lung, were involved in one solid tumour, it was deemed expedient to divide the clavicles at their outer third, and the first rib at the vertebral side of the subclavian groove, and separating the parts from the vertebral column, downwards from the base of the skull, as far as the diaphragm, so as to remove them in a mass for further inspection. The following is an account of the pathological condition of the parts:— After an injection of coloured size had been thrown into the thoracic duct, the veins and right side of the heart, along with the pulmonary artery, became moderately distended, and at the same time the injection oozed out from the lower openings, communicating with the slough in the lower part of the neck, showing that the cavities of veins or lymphatics communicated freely, by open orifices, with this sloughing part. The thoracic duct was entire. A large tumour was now evident, most con-