Aneurisms of the arteria innominata : their history and differential diagnosis from aneurisms of the arch of the aorta / by T.S. Holland.
- Holland, Thomas S.
- Date:
- 1852
Licence: Public Domain Mark
Credit: Aneurisms of the arteria innominata : their history and differential diagnosis from aneurisms of the arch of the aorta / by T.S. Holland. 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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![phagus. On a level with the top of the sternum double pulsation was heard; left arm cold and blue; no pulsation in the left radial or humeral arteries. The state of the right arm and right radial pulse was normal. M. le Docteur Berard diagnosed an old aneu- rismal dilatation of the transverse aorta, or of one of the trunks origi- nating from it; rupture of the old sac, without hemorrhage, causing the sudden appearance of the tumour, and the state of the left arm caused by a clot in the subclavian artery. Death, occurred during a paroxysm of dyspnoea. Post mortem—Dilatation of the brachio-cephalic trunk, the left subclavian obliterated by a clot of recent origin. The relations of the tumour rendered an exact explanation of the pain in the course of the oesophagus, of the dyspnoea, and of the sibilant character of the respiration. [This is all that is said regarding the position of the tu- mour.] The left common carotid arose from the arch by two dis- tinct branches united by a band of areolar tissue and soon forming one trunk. No. 35. M. Chapelle’s Case, Bulletin de la Societe Anatomique, 1848, p. 291.—A carpenter, aged 46 (a drunkard), complained of pain in the right shoulder in July, 1843, followed in November by the appearance of a tumour. When admitted to the Hopital St. Antoine, under M. Malgaigne, the tumour, as large as a hen’s egg, pulsated in all its parts, having its base covered by the sternum and the internal border of the right clavicle. M. Malgaigne intended tying the^ subclavian and carotid arteries, but only tied the latter vessel, the patient being too much exhausted to justify a second ope- ration, as the carotid, being far to the external border of the sterno- mastoid, had rendered the operation very tedious; tumour dimi- nished very much in size, and he left the hospital much relieved, but against M. Malgaigne’s advice. On the 30th July he was admitted to the Hopital St. Louis, at which time the tumour was larger than before the first operation; a prolonged impulse was heard over the tumour, followed by a period of repose, to which succeeded a bruit, clear, short, and replaced immediately by the long impulsive sound; the length of the impulsive sound, and the absence of any pause after the second sound, prevented the movement and bruit of the aneurism from being synchronous with the heart sounds. The cir- culation was re-established at the right side of the head; right pulse smaller than the left; he spoke a little hoarse, had some slight diffi- culty in swallowing; pain in the right shoulder and arm, at times very intense; slept on the left side, the pain and difficulty of breath- ing being increased in any other position, and he complained of a pricking sensation in his eyes. M. Malgaigne tied the subclavian on the 13th October, just seven months after the first operation. On the 5th of November dyspnoea re-appeared; on the following day the dyspnoea had increased in intensity, though the tumour was less apparent; he died asphyxiated on the following day. Post mortem.—The sac occupied the termination of the innomi- nata, engaging the primitive carotid and subclavian. The carotid](https://iiif.wellcomecollection.org/image/b22327800_0028.jp2/full/800%2C/0/default.jpg)
