Diseases of the chest and the principles of physical diagnosis . Aneurisms Involving the Thoracic Aorta.— 1. Aneurism of the Intrapericardial Portion of the Arch and Sinuses ofValsalva.—When the thoracic aorta is involved, the aneurism most fre-quently occurs in the ascending portion of the arch. This is due to thefact that a syphilitic mesaortitis is so commonly limited to the first portionof the vessel. It may involve one or all of the sinuses of Valsalva. Inthis situation the aneurism is usually small, and deeply placed; it isfrequently first discovered at the autopsy table or as the result
Diseases of the chest and the principles of physical diagnosis . Aneurisms Involving the Thoracic Aorta.— 1. Aneurism of the Intrapericardial Portion of the Arch and Sinuses ofValsalva.—When the thoracic aorta is involved, the aneurism most fre-quently occurs in the ascending portion of the arch. This is due to thefact that a syphilitic mesaortitis is so commonly limited to the first portionof the vessel. It may involve one or all of the sinuses of Valsalva. Inthis situation the aneurism is usually small, and deeply placed; it isfrequently first discovered at the autopsy table or as the result of an X-rayexamination (see Fig. 423). During life the clinical picture is apt to bethat of angina pectoris or aortic insufficiency. This is due to the factthat the exciting cause of the aortitis may lead to a partial occlusion of theorifices of the coronary arteries or it may produce aortic incompetence,either by dilating the aortic ring or by extension of the disease to the valveleaflets. In the presence of either one of these conditions, therefore, an. Fig. —Large aneurisrnal Iuiumi to the left of the sternum. aneurism should be suspected. An aneurism in this situation may com-press the superior vena cava and thus cause congestion of the face orundue fulness of the jugulars and the veins of one or other upperextremity. 2. Aneurism of Ascending Arch.—This includes that portion of theaorta between the sinuses of Valsalva and the orifice of the innominateartery. An aneurism in this situation commonly attains a very large sizeand this may occur without symptoms, or the symptoms may be verytrivial in nature. For this reason an aneurism affecting this portion of theaorta has been called the aneurism of physical signs. The heart is oftendislocated downward. The aneurismal tumor extends upward and tothe right appearing in the second and third interspaces to the right of thesternum (see Fig. 418); it may, however, appear to the left of the sternum(Fig. 42
Size: 1351px × 1850px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1920
