Cirsoid aneurism is most frequently found on the scalp and face, but it may likewise be found in the tongue, extrem ities, internal viscera, and bones.
Prognosis.—Although a cirsoid aneu rism may not grow or change for many years, it may also steadily develop in size and spread by invading the vessels of the surrounding tissues. The thinness of the overlying skin presents constant danger, and rupture of one of the ampullm may give rise to uncontrollable hmmorrhage.
Treatment. — Removal by excision is, by far, the best procedure to use, with complete arrest of the hozmorrhage by ligation of the afferent and efferent ves sels. Among the other measures recom mended have been ligation of the various afferent arteries, coagulation of the blood by means of various injections, the gal vanocautery, electropuncture, and acu pressure. But none of these afford satis factory results in the great majority of eases. In multiple cirsoid of the hand or other extremities, amputation some times becomes necessary.
Case of extensive cirsoid aneurism of the scalp, cured by multiple ligatures. Mynter (Annals of Surg., Feb., '90).
Case of cirsoid aneurism with liga ture of the common carotid artery. Decided improvement, notwithstanding heavy work. W. D. Hamilton (N. Y. Med. Jour., Nov. 3, '94).
Ursoid aneurism of the scalp follow ing a fall against a curb. In spite of the probable li[uniorrhage, the best treatment in this location is excision of the aneurism entire. The child was well in a week. Broca (Jour. de Chir., Apr. May, 1001).
Arterio-venous Aneurism. Varieties.—An artery and a vein may intercommunicate in two ways: (1) when the one vessel opens into the other by a short channel—the so-called aneurismal varix—and (2) when between the two Successful result in a ease of large cirsoid aneurism of the scalp. Blood supply controlled by aeupressure-pins applied to external terminal branches of nutrient arteries. Subsequent crucial in cision and vascular tissue entirely re moved between the skin and periosteum of flat bones. Compression applied; complete recovery. W. S. Forbes (Med. News, June 15, '95).
Case of cirsoid aneurism of the scalp: ligature and acupressure followed by im mediate and complete excision: recovery. J. J. Pratt (Lancet, July 3, '97).
vessels there is an adventitious sac: the so-called varicose aneurism. Although
both terms are incorrect and misleading. they serve to establish a distinction which becomes important when the treatment is considered, the measures indicated in aneurismal varix being dangerous in vari cose aneurism.
The difference between the two varie ties is illustrated in the wood-cuts printed above.
Symptoms.—The receipt of the injury may be attended by syncope if internal vessels arc wounded, but superficial ves sels are by far those most frequently in volved, and aneurismal varix may last for years without serious disturbance. The most common situation of this variety is the bend of the elbow, the result of punctured wounds which penetrate both vessels.
A whirring sound, like the purring of a kitten, is produced by the current passing from the artery into the vein. This sound was compared by Spence to the noise made by a fly in a paper bag. It is more distinct above than below the tumor, and the limb is usually somewhat weaker and colder than is natural. A thrill is felt when the hand is applied over the tumor.
In varicose aneurism there exists, as already stated, a sac between the two vessels; but it is important to remember that this sac is not constituted of the coats of the vessels involved; it is an artificial formation at the expense of the tissues between the vessels. These having been simultaneously wounded, the lymph effused in the course of the inflammatory process forms a partition to limit the extravasation. This extrav asation differs from that of a false aneu rism in that it communicates with a vein.
The difference between aneurismal varix and varicose aneurism consists, besides the presence of the adventitious sae, of a greater length of the interven ing canal in varicose aneurism. A lami nated clot on each side of this canal con tributing also to reduce its diameter to that of the canal in aneurismal varices, taken as a whole, the symptoms of both conditions are about similar. Palpation sometimes makes it possible to detect the presence of the intervening sae. and also, in addition to the thrill and buzzing sound of aneurismal varix, a distinct im pulse. An aneurismal murmur or soft bruit may frequently be elicited. The conformation of varicose aneurism is not such as to tend toward much enlarge ment.