Heart disease and aneurysm of the aorta, with special reference to prognosis and treatment.

  • Broadbent, W. H. (William Henry), Sir, 1835-1907.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Heart disease and aneurysm of the aorta, with special reference to prognosis and treatment. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    been sufficient, even in the absence of pitlsation on the chest wall, to enable one to come to a diagnosis of aneurysm. (4) Aneurysms of the Third or Descending Part op THE Arch. The descending aorta is deeply seated, lying to the left side of the bodies of the fourth and fifth dorsal vertebrae. The only important structures in immediate relation are the oesophagus and thoracic duct, which lie to the right of the aorta. Pressure symptoms are consequently not, as a rule, characteristic, and as the aneurysm rarely comes to the surface, physical signs are usually ill-marked. There may, however, be dysphagia from pressure on the oesophagus, and a not uncommon termination is rupture of the aneurysm into the oesophagus. Frequently the only symptom com- plained of is pain in the back, a pain radiating down the left arm or round the left side of the chest: there may be no other physical signs or symptoms present. The pain is due either to irritation of a spinal nerve, when it may radiate round the left side of the chest, or to erosion of the vertebrae, when smartly tapping the affected vertebra sometimes increases the pain. Diagnosis is in most cases a matter of considerable difficulty. The aneurysmal sac may, however, enlarge in such a direction as to press on the root of the left lung and the recurrent laryngeal nerve. In one case, where the patient had been sent to the hospital for chronic laryngitis and attacks of paroxysmal dyspnoea, the left vocal cord was found to be paralyzed, and there were signs of pressure on the left bronchus, which seemed to point to aneurysm of the trans- verse part of the arch. At the autopsy, however, an aneurysm was found involving the aorta to the left of the bodies of tlie fourth and fifth dorsa] vertebrae and adherent