ACQUIRED DISEASES OF THE BLOOD VESSELS 1. Aorta.—Aortic affections are exceptions, on account of the rare occurrence of arteriosclerosis, although in childhood also aortic aneurysms and inflammatory changes of the vessel have been described by Martin, de la Rue and Marfan. Hochsinger has seen aortitis twice in children with congenital syphilis, aged eight and eleven years. Acute aortitis does not occur in childhood; the chronic form is also rare and almost always depends upon syphilis. Chronic aortitis with spindle shaped dilatation of the trunk of the vessel has been observed by Zuber and Merget Guillemot, in recurrent articular rheumatism.
Chronic aortitis causes no other symptoms in children than in adults. Retrosternal pains and attacks of dyspncea are most prominent. Systolic murrnurs over the aorta and in the neck, eventually upward projection of the arch of the aorta itself, form the objective symptoms.
Marfan distinguishes a rheumatic and an atheromatous form of aortitis in children. The former is masked by symptoms of stenosis and insufficiency of the aortic ostium, only it often leads to continuation of the inflammatory process upon the inside covering of the trunk of the aorta, to loss of elasticity and dilatation, with the occurrence of asthmatic attacks (Cadet de Gassicourt). The atheromatous form has repeatedly been observed, even in early childhood (Hodgson, in a child of fifteen months, Moutard and Martin in one of two years). In older children such observations become more numerous.
According to Malian hypertrophy of the left ventricle is absent for a long time with chronic aortitis in children, thus differing from stenosis of the aortic ostium.
Aneurysm of the aorta has even been observed in the feetus (Rho nomenow, Durante). In an inaugural dissertation De la Rue calls from the tenth to the fifteenth year of age the age of predilection for child hood, yet a case has been described in a child of four months and sev eral cases in the fourth and fifth years of life.
According to Lidell, who has grouped 213 fatal eases of aneurysms according to age, seven occurred in children of from 2 to 5 years; one from 5 to 10 years; two from 10 to 15 years; in all ten during childhood.
Jacobi saw an aneurysm of the abdominal aorta in a child and Friihwald observed rupture of an aneurysm of the innorninate artery into the trachea, after tracheotomy, in a girl aged three and a half years.
Etiologically the acute infections diseases are to be considered, especially syphilis. The seat of aortic aneurysm in childhood is chiefly the arch of the aorta. Another seat of choice is upon the concave sur
face of the aorta, very close to where the ductus Botalli, i.e., ligarnen tum arteriostun, branches off.
All the symptoms well known from the pathology- of adults are to be considered in the diagnosis. Radioscopy offers most valuable assist ance in the diagnosis of this condition even in childhood.
Therapeutically, for aortitis as well as aneurysm of the aorta, the administration of iodine is most important (0.2-0.5 Gm. (3-7 gr.) of sodium iodide daily).
2. The Peripheral Arteries. —As h result of the action of specific microorganisms, an acute inflammatibn, leading to thrombosis and gangrene, appears sometimes in the course of an infectious disease, in one or more arteries. This has been observed after typhoid fever, scarlet fever, diphtheria, croupous and catarrhal pneumonia, The femoral artery is the favorite seat of inflammatory thrombosis; in a case observed by Hochsinger in a newborn infant with pneumonia the long thoracic artery showed thrombosis.
These inflammatory arterial thromboses ill children must be dif ferentiated from arterial emboli which,while less frequent than in adults, occur nevertheless in heart affections, with the production of intra cardial thrombi especially. The most frequent emboli are found in the artoies of the brain.
Sclerosis of the peripheral arteries in childhood occurs almost exclusively with syphilis and has been observed by Berghinz in infants aged seven and eighteen months. Seitz describes its appearance as a result of the acute infectious diseases of children, haling observed with it accentuation of the second sound at the aortic area and hypertrophy of the left side of the heart. In general though, this affection belongs to later childhood. Aneurysm of the peripheral arteries, especially of the cerebral arteries, also occurs in childhood, depending chiefly upon syphilis (Crisp, Kingston, Lebert, Oppe). Cranwell observed an aneurysm of the axillary artery in a boy of fourteen years, 3. The Veins.—Inflammations and thromboses of the veins, due to infecting microorganisms, are not so rare in childhood as inflammations of the arteries. Here belong sinus thromboses and thromboses of the inferior vena eava, the symptonis of which do not differ from those noted in older individuals. In thromboses of the superior vena cava recovery has been observed after a collateral circulation has developed, a rare occurrence in thrombosis of the inferior vena cava.