Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

    22/78 (page 16)
    the veins of the neck engorged. There was evidence of pleuritic effusion on the left side, and there was dulness over the sternum and to the right of the lower part of that bone, which could not be accounted for simply by assuming a displacement of the heart by the pleuritic effusion. This dulness, as the post-mortem examination proved, was due to the increase of the tissue in the mediastinum, to the caseous mass which was present there, and to the enlargement of the right side of the heart, secondary to the adherent pericardium. The liver at this time was enlarged in consequence of the venous engorgement, but there was no ascites nor anasarca. Although the veins of the neck were much engorged they did not_become more swollen during inspiration, as has been seen in some cases of mediastino-pericarditis ; but another feature of that affection was present—viz., the pulsus paradoxus. Pleuritic effusion • of the left side accumulated again and again after tapping, until a drainage tube was inserted into that side, with the result of causing a union of the parietal with the visceral layer of the pleura, and conse- quent obliteration of the left pleural cavity. Relief followed this operation for a time, but subsequently pleuritic effusion developed on the right side, the heart became more dilated and feeble, anasarca and ascites ensued in consequence of cardiac dilatation, and the boy succumbed, chiefly from the effect of the condition of the heart. Ascites, which sometimes forms a prominent feature of the cases of mediastino-pericarditis, was absent in this patient until a late stage of the illness, and was then clearly a part of the general dropsy, which resulted from the venous engorgement consequent upon the cai'diac dilatation. Inspiratory swelling of the veins of the neck was also not present. The pulsus paradoxus, which is frequently present in such cases, but as we know occurs in other affections also, was marked in the above case. Another physical sign which was present is well worth a few considerations : This sign is the bronchial breathing which was observed in front to the left of the sternum, and the same type of breath-sound which at a later period of the boy's illness (April, 1891), was so marked in the upper part of the inter-scapular region of both sides. The bronchial respiration present, when he first came under my observation, to the left of the sternum, was clearly associated with the accumulation of fluid in the left pleural cavity, and the displacement of the left lung brought about thereby, because, when the fluid was removed by aspiration, weak vesicular respiration replaced the bronchial breathing, and as the fluid re-accumulated and reached its previous limits, the breath sounds again became bronchial at the same spot.