ARTERIAL PULSATION. — Localized, Thoracic aneurism. Examination with fluoro scope: The curved line in the upper part of patient's left chest and the curved line on his right chest indicate the outline of the aneurism as seen in the fluoroscope. The lower curved line on the left chest marks the outline of the heart; the lowest curve on the right front, part of the outline of the diaphragm; the dotted line, the cardiac area as determined by percussion. This case shows how a large aneurism may exist in the chest without giving rise to marked physical signs. (F. H. Williams, Amer. Jour. Med. Sei., Dec., 'K.) but not persistent, pulsations of arteries may simulate aneurisms, and have been described by Paget and West under the names of mimic or phantom aneurisms.
AND EMPYEMA.—These complications of pleuro-pulmonary dis eases may be simulated when an aortic aneurism has ruptured.
Value of x-rays in the diagnosis of thoracic aneurism in which the outlines of the aortic swelling are clearly shown. In one case (possibly of tuberculous adenitis), in which the symptoms sug gested an aneurism. the sciagraph showed no enlargement of the aorta. The arrest of the x-rays by an aneurismal tumor is due to the blood and probably to the iron contained in it Tuberculous de posits are thought to be impervious to the rays, but this is still a matter of some uncertainty. In the cases in which aneurism existed, the diagnosis had al ready been made, but the picture made by Roentgen rays confirmed this diag nosis. William Pepper (Med. Record. Nov. 28. '96).
Aneurisms of the thoracic aorta can sometimes be detected earlier by x-ray examination than in any other way. In obscure cases, where an aneurism of certain portions of the aorta is suspected, but does not exist, it may be excluded by an x-ray examination. (Sec wood cuts.) Francis H. Williams (Amer. Jour. Med. Sciences, Dee., '07).
As aneurisms of the valves are chiefly dependent on endocarditis and atheroma, the symptoms are those of these diseases, and they have no separate symptoma These two figures show a smaller aneurism of the aorta. The arrow on the dorsal side points to where the pulsation was best seen.
(F. H. Williams. Amer. Jour. Med. Sri., Dec.. '07.) tology; yet the ausculta tory phenomena may have diagnostic significance. Aneu rism of the mitral may produce a rudimentary murmur immediately fol lowing the systole. Frequently in per forated aneurisms the sounds are most peculiar: humming, blowing, groaning, hissing. singing, whistling, scratching, piping, or musical. A musical murmur, especially in the aorta, which was not present in an apparently-healthy indi vidual the day previously, may be looked upon as dependent on valvular aneurism. Musical murmurs due to aneurisms may disappear for days and then return. They may vary in time, place. and quality. They can only be properly in terpreted when taken in connection with other physical signs yielded by the heart. Drasche (Wiener klin. Woeh., Nov. 10, '98).
Diagnosis between aneurism and me diastinal tumors based upon 150 eases of aneurism, 200 cases of stenosis of the cesophag,us, and a large number of other eases of mediastinal tumor. The most important signs of mediastinal disease are stenosis and pressure-paralyses of the recurring nerve. Tracheal stenosis is the most important of the various forms of stenosis, and if it is present the probability of the presence of aneu rism is very great. Permanent signs of stenosis of the (esophagus constitute almost secure evidence of mediastinal disease. and exclude aortic aneurism. Hampeln (Zeits. f. klin. Med., B. xlii, H.
and 4, 1901).
Five eases in which the Roentgen rays proved of value in the diagnosis of tho racic aneurism. A transverse position of the heart is an important sign. Walsham (Edinburgh Med. Jour., Apr., 1901).
Etiology. — Age is an important fac tor, aneurisms being observed especially in adults in their prime: i.e., between thirty and forty years of age. This is due to the fact that men are still en gaged in vigorous occupations at that age, neither the heart nor the muscles having lost their strength, while it is then that arteries begin to show symp toms of degeneration. In very young people aneurisms are exceedingly un common.