Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

    63/78 (page 57)
    lower border of the first rib. This extensive mediastinal dulness may be found where there is very little increase of mediastinal tissue, aa shown by my second case. In such instances of extensive mediastinal dulness, the probability will be that the cause of the dulness will be found to be due to the cardiac enlargement rather than to the mediastinitis. In some cases, however, enlarged caseous glands, together with the increase of the fibrous tissues in the mediastinum, may contribute, apart from the enlarged heart, to produce a dulness over the upper part of the sternum (Case 23 in the table). The heart sounds may be natural, weak, or if there is independent valvular disease, we may have one or more murmurs present. The increase in the size of the liver is usually due to marked venous engorgement of the organ, which is chiefly the result of the cardiac dilatation, possibly in some cases, assisted by the fibroid change in the mediastinum, obstructing the inferior vena cava. A certain amount of increase of the fibrous tissues of the liver has also been found, probably a secondary efiect of the chronic venous congestion of the organ. I think, however, such increase has never been a very marked one, and such as would be sufficient to account for the production of ascites from portal obstruction. The spleen has usually been found not to be enlarged, a fact of consider- able interest and importance when considering the cause of local dropsy of the abdominal cavity in those cases where such dropsy has been found with little or no anasarca of the extremities. The spleen was, however, considerably enlarged in one case (Claessen's). Anasarca, especially of the lower extremities, is commonly present at some period of the cases of indurative mediastino-pericarditis. It may be a marked feature of the case during a prolonged period, or only slight, and occur late on in the course of the disease. This was so in my two cases above recorded; the dropsy of the lower extremities was never very extreme, and occurred late in the course of the disease. In those two cases it was probably due to the gradual onset of cardiac dilatation, and such is the probable explanation of it in the majority of cases of medi- astino-pericarditis rather than any direct narrowing of the inferior vena cava by the fibroid change in the mediastinum. As a part of the general dropsy we may also have ascites, and in some instances, as was notably so in Case 2 {ie,, Case 24 in the tables), the ascites may be one of the most marked features of the case, and be present with little or no anasarca of the extremities. This point, the occurrence of ascites, with little or no general anasarca, has been already partly discussed in the remarks on Case 2 (see page 26). The connection of such ascites with indurative mediastino-pericarditis cannot be considered a settled one. We see some cases of this disease,