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
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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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    enter the Hospital at Montpellier on the 6th August, 18;36; bleed- ing relieved the intense dyspnoea but little, and he died sufhjcated; lesion of the vessels not being suspected, though the lungs were frequently examined. Post mortem.—Interlobular emphysema: an aneurism of the brachio-cephalic trunk was found, as large as a turkey’s egg, having perforated the trachea at three points ; some spiculee of phosphate of lime had passed from the walls of the sac into the trachea, and rais- ing the mucous membrane about two inches from the origin of the bronchi, appeared (when seen from the trachea), as raised reddish tumours under the mucous membrane. [This case was reported to M. Dubrueih] No. 39. M. Dubrueil’s Case, Sur les Anevrysrrm de la Portion As- cendants ei de la Crosse de VAcrte, p. 129—A man in the prime of life was seized suddenly with severe dyspnoea and violent convul- sive cough, which he attributed to having a few moments before made a violent effort in raising a bag of corn; the dyspnoea conti- nued, and he was obliged to leave his work. Six months after, a tu- mour, the size of a nut, was seen pulsating at the inner third of the right clavicle. The tumour had acquired an immense size, pressing outwards the lower half of the neck, and extending downwards into the chest, as low as the third rib; it passed transversely across the chest from the internal third of the right clavicle to the sternal in- sertion of the left sterno-mastoid; over the part of the tumour that was within the chest a hruit de souflet w'as heard, so loud as to strike the ear, while over the portion that was external to the chest and above the clavicle a purring murmur existed, such as is heard in external aneurism. His respiration was loud and wheezing, voice raucous, the patient even aphonic at times; right arm infiltrated with serous efifusion; right side of the face wasted; deglutition always painful and sometimes impossible; left pulse natural at 56; right thread-like. Pulsation can scarcely be felt in the right common carotid, and was absent in the temporal of that side; the fits of coughing, without expectoration, became more frequent and A'io- lent; the sac burst externally, and death was instantaneous. Aneu- rism of the innominata, connected with, and dependent upon aneu- rism of the transverse portion of the arch, had been diagnosed. Post mortem The arch was found perfectly healthy, though the entire of the innominata w'as engaged in the aneurism ; rupture had occurred at the highest point; a coagulum rendered the right com- mon carotid completely impermeable; the subclavian was also con- siderably diminished in size ; not far from the cricoid cartilage the tumour rested on the trachea, thereby causing flattening and thin- ning of Imir of its rings. No. 40. M. Planque’s Case, Bihliotheque Choisi de Mcdecine, 1759, vol. X. p. 276—A soldier, aged 46, admitted to the Infirmary of the Hotel des Invalides, complaining of cough, with bloody ex- pectoration and pain in the throat, these symptoms having existed for the past six weeks. A tumour was found at the anterior and inferior part of the neck, immediately above the sternum, pulsating regularly, and capable of being emptied, but immediately refilling