Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell.

  • George Alexander Gibson
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell. Source: Wellcome Collection.

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

    107/412 (page 89)
    deposit at the bases of the aortic cusps, may be very readily, and is often, mistaken for aneurism. The differential diagnosis is probably often impossible, but the correspon- dence in the physical signs in the two conditions must be borne in mind. The points in which they correspond are the presence of pulsation in the episternal notch, increased urea of dulness, systolic murmur, and accentuated aortic second sound. Pressure symptoms are not, however, present. (2.) Descending Thoracic Aorta.—This part also of the vessel may be the seat of aneurism. If it is large its posi- tion may be made out by percussion, and there may be a murmur. If erosion of the vertebr£e has supervened there is tenderness on pressure, while in severe cases there may be spinal curvature and paraplegia from implication of the cord. Minor degrees are hardly discoverable by physical examination. (3.) Innominate Artery.—Thi^ vessel is often involved in aneurism of the aortic arch ; it may, however, be affected apart from it. The bulging, unless the sac be very large, is to the right of the sternum, and reaches to the level of the sterno-clavicular articulation. The orifices of the right subclavian and aortic arteries are very liable to be impli- cated, and to lead to a difference in the radial and carotid ])ulses on the two sides. The other signs correspond with those of aneurism of the arch, but the pressure phenomena are not so varied. (4.) Abdominal Aorta.—Aneurism of this part of the vessel will be found under the section on the abdomen. (5.) Carotid Arteries.—Normally the pulse in these vessels is not visible. In double aortic lesion—that is, when there is both stenosis and regurgitation—the pulsation of the arteries, especially the right one, is visible right up to the ear. This is the only valvular lesion in which this pheno- menon is present; it may, hoAvever, be present in exoph- thalmic goitre without lesion at the aortic valves. We have already mentioned that systolic aortic murmur is propa-