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.

    64/78 (page 58)
    of which Case 1 (page 9) is a very good example, where we have through- out the whole course of the affection no marked ascites, and only sucii as is part of a general dropsy, and can be explained as the result of tiie cardiac dilatation. Other cases, however, are seen, of which Case 2 is a typical example, where the ascites is one of the most prominent featui'es of the case, and where it occurs without any or only slight oedema of the lower extremities. Ascites without anasai'ca is therefore not present in every case of mediastino-pericarditis; it occurs in some, it does not occur in others. When it does occur we can only explain it as due to the occurrence of a complication to the primary disease, or as due to a lesion independent of the mediastino-pericarditis. There are two lesions either of which may possibly occur as complications to the mediastinal and pericardial affection, and which would explain the ascites in such cases. In the first place, it is conceivable that chronic venous congestion of the liver produced by the cardiac dilatation may in some cases set up a chronic inflammation of the liver, a secondary peri-portal cirrhosis, which like the ordinary alcoholic cirrhosis would obstruct the portal circulation, and produce ascites. We have seen that an increase of fibrous tissue in the liver is found in some of the cases of mediastino- pericarditis, but such a change does not appear to be the rule, and in the cases where it has been found it is questionable whether it has been sufficiently pronounced to produce portal obstruction and ascites there- from. Furthermore, in one of my own cases (Case 2) where the abdominal dropsy was such a prominent feature of the illness, the ascites was certainly not due to a cirrhotic liver, no marked peri-portal cirrhosis being found on microscopical examination. The second explanation of the occurrence of the ascites in the cases under consideration is that a chronic peritonitis ensues, and to it the ascites is due. Such chi-onic peritonitis, in some instances, may possibly be an independent affection, and one not directly connected with the mediastinal or pericardial lesion; in other cases it is conceivable that the chronic venous congestion, due to the interthoracic affection, sets up a chronic peritonitis. Such a chronic peritoneal change was found in my second case, and was clearly sufficient to account for the ascites. That it is the explanation of the ascites in all such cases, of course we do not say. It is quite possible that other complications may in some cases occur which account for the development of ascites as a prominent feature of the case.' As I have stated before, we do occasionally meet with cases of ordinary obstructive heart disease where ascites is present in ' Acute tuberculosis of the peritoneum was found in one case of indurative mediastino-peri- carditis, where marked ascites was present. Dr. A. W. Fox.—British Medical Journal, 1S77, Vol. II. p. 470. (Case 14 in table.)