Case of aneurism of the ascending aorta opening into the right auricle : fatty degeneration of the muscular substance of the heart / by Thomas Bevill Peacock.

  • Peacock, Thomas B. (Thomas Bevill), 1812-1882.
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the ascending aorta opening into the right auricle : fatty degeneration of the muscular substance of the heart / by Thomas Bevill Peacock. Source: Wellcome Collection.

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

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    thinner than usual, and covered by a thick deposit of fat. The mus- cular substance had also undergone the fatty degeneration; it was of a pale yellow or clay colour. The auriculo-ventricular and pulmo- nary apertures and valves were healthy. The cavity of the left auricle retained its usual dimensions, its parietes were somewhat hypertrophied, and the appendage contained a firm decolorized clot. The mitral valve was natural. The left ventricle was greatly dilated and hypertrophied, and the inner layers of its muscular parietes had undergone the fatty degeneration, but the change was less marked than in the walls of the right ventricle. The outer wall measured near the base, five lines in thickness, and at a point midway between the base and apex, four lines; below this the mus- cular substance became gradually thinner, and was replaced by a layer of fat; at the apex, where the deposit of fat was very co- pious, the muscular substance was reduced to a mere film. The aortic valves were slightly thickened. The sinuses of Valsalva were somewhat dilated, more especially the posterior sinus, which formed a slight projection into the cavity of the left auricle. The ascending aorta was the seat of a large aneurism. This commenced about a quarter of an inch above the attachment of the right and posterior semi-lunar valves by a tolerably distinctly defined margin, and involved chiefly the anterior and right side of the vessel; below, it pressed upon the base of the right ventricle, and the appendage of the right auricle: and above, it terminated somewhat abruptly an inch and a quarter below the origin of the brachiocephalic trunk. An oval cavity was thus formed which would contain a duck's egg, having the obtuse extremity below, and the origin of the aorta near the middle of its left side. The inferior portion formed an egg-shaped swelling pro- jecting into the right auricle, immediately below the entrance of the vena cava descendens; and on the left side of this projection, in the appendage of the auricle, there existed two apertures, by which the cavity of the aneurism communicated with that ot the auricle. These apertures, each of which was of sufficient size readily to give passage to a large bougie, were situated imme- diately together, and were surrounded by a belt of smal granular concretions of decolorised lymph. In several of the sulci of the auricle, the septum between the aneurismal sac and its cavity was so thin as to be completely translucent. The descending cava, though compressed by the sac of the aneurism, and, as it were, ex- panded over its right side, was free from obstruction, but its coats were much thickened. At the upper portion of the aneurismal the wall was in front so extremely thin, that had the peri- cardium not been here firmly adherent and much thickened it mu have given way some time before the actual occurrence of the fatal event The lining membrane of the artery was continued toughout the aneurismal sac, and numerous atheromatous and