Case of diffuse popliteal aneurism caused by an exostosis due to ossifica tion of the tendon of the adductor mag nus muscle. Similar ease reported by Boling quoted in which rupture of the artery was caused by two epiphyseal exostoses. Terrier and Hartmann (Lon don Lancet, May 20, '93).
Symptoms. — Although a sudden pain may reveal the presence of the aneurism, rheumatism of the knee is the usual complaint at the start. The joint then becomes weak and stiff, and examination finally reveals a growing tumor, pre senting all the characteristics already de scribed: expansive pulsations and bruit extending down the leg. The aneurismal tumor can usually be emptied, but in some cases all the subjective symptoms have to be very carefully sought after to be discovered. The tibial pulses usually show a marked difference. Complica tions frequently followed popliteal aneu rism. Posteriorly, it may compress the veins and cause oedema, or give rise to severe neuralgia by pressing on the pop liteal nerve anteriorly; synovitis may be induced, causing severe pain.
Case of pulsating tumor of the pop liteal space simulating aneurism; illus trates importance of using exploring needle in deep-seated fluctuating tumors. Marinaduke Shield (London Lancet, Oct. 6, '94).
Case of popliteal aneurism showing, as only symptom, cramp-like pain in the leg. J. Hutchinson, Jr. (Med. Press and Circ., Oct. 16, '95).
Differential Diagnosis.—Arterial hm atorna presents the characteristics of pop liteal aneurism even when no trauma is found. The bruit may be present, but the pulsation along the course of the vessel is weaker. Osteosarcoma, glandu lar enlargements, abscess, cysts, may also simulate a popliteal aneurism, but the expansile nature of the latter, and the possibility of emptying the sac, make it impossible to readily establish the nature of the case.
When the femoral artery above does not feel rigid, the aneurism is not due to atheroma and there is no atheromatous degeneration in the vicinity of the sae. Biliroth (Wiener klin. Woch., No. 50, '93).
Prognosis.—Popliteal aneurisms occa sionally undergo spontaneous cure. Usu ally, however, it progresses more or less rapidly according to its location; begins to leak; and finally ruptures into the surrounding cellular tissue, the blood ex tending along the tissues of the leg. The popliteal space becomes at once greatly distended. Considerable pain and faint ness are experienced. The typical local symptoms do not cease, however, al though considerably reduced in intensity.
The limb below becomes livid and cold, and gangrene soon follows, if an inflam matory process does not come on. In the latter there is redness of the skin, local oedema, and severe pain. Suppuration of the joint is then probable.
[Two cases of this kind witnessed by me were cured by means of the iodide of potassium and compression. Both pa tients are now strong and healthy. J. McFADDEN GAsToic.1 Treatment. — If there is evidence of atheroma digital compression should be preferred, provided there is no fear of impending rupture. Esmarch's bandage may also be employed. Flexion is useful if the aneurism is small. If these fail, ligation of the femoral artery at the apex of Scarpa's triangle gives the best results. The limb should be carefully wrapped in cotton wadding and raised somewhat. This is especially indicated when the sac is large, if it is inflamed, when leaking has begun, or when, through pressure on the popliteal vein, there is oedema of the foot.
Amputation is indicated when gan grene follows ligature, when the sac has ruptured, or if there is caries of the osseous tissues or suppuration around the sac.
Case in which total extirpation of the sac was followed by speedy recovery. Statistics of forty cases confirming this opinion, twenty-eight being cases of arterial aneurism and twelve arterio venous. Kubler (Beitrfige zur klin. Chi., 13. 9, II. 1, '92).
Case of bilateral popliteal aneurism; sacs extirpated in two sittings with com plete success. Ten cases of this affection reported, with nine recoveries and one death from sepsis. Schmidt (Archiv f. klin. Chi., vol. xliv, p. 809).
Popliteal aneurisms, if not too large, permit of the radical operation. The portion of the artery within the aneu rismal sac is denuded and its walls are softened. Secondary hwmorrhage is likely to follow ligation at this point. The ligature should be applied outside of the sac or at a distance from the open ing in the wall of the artery into the sac. Primary union of the walls of the sac is not to be expected. The inner portion of the sac becomes detached by necrosis. Extirpation of the wall of the sac is not necessary. The wound should not be entirely closed by sutures: the cavity should be loosely packed with iodoform gauze. In the after-treatment iodoform and-glycerin emulsion is recommended.