Thoracic Aneurysm: Report of Case

Abstract

This case is reported for the following reasons: 1. The aneurysm is an unusually large one. 2. An opportunity is given to observe the progressive increase in size which an aneurysm may undergo in one year. 3. The destructive force of a pulsating, blood-filled aneurysmal sac is well illustrated. Case No. 23,545, Emory University Division, Grady Hospital, Atlanta, Georgia. H. T., colored laborer; age 37; chief complaint, “knot in left side; pain through the heart.” Admitted February 14, 1927. Family history, negative, Marital history, married twice. (First wife died with miscarriage; no children by second wife.) Past history, negative. Present illness: Onset in January, 1926, with dyspnea, and pain in left chest and back. Most severe over precardium and in left axilla. Admitted to Medical Clinic, Out-patient Department, on February 23, 1926, complaining of pain in left side, over lower sternum and axilla. Physical examination showed a heart hypertrophy to the left and downward. On February 26, 1926, fluoroscopic and teleoroentgenographic examination (No. 1,220) showed left ventricular hypertrophy; dilatation of upper portion of descending aorta, without the visualization of a distinct aneurysmal sac. A slight bulging of the descending aorta into the posterior mediastinum was noted. Due to the presence of almost constant thoracic pain, and the dilatation of the aorta, the diagnosis of probable early aneurysm of the descending thoracic aorta was made at this time. March 1, 1926, blood Wassermann was reported four plus. Patient was referred to Syphilitic Clinic for treatment, but there is no record of his having received such treatment. Patient resumed his occupation as a shoe packer, and continued same until September, 1926, when the pain in left chest became more severe, and he noticed the appearance of a small mass about the size of a hen's egg on the left posterior chest wall, about one hand's breadth from the spine and at the level of the ninth rib. The pain grew progressively more severe, the mass gradually increased in size, and the patient became unable to lie on the left side. He did not return to the Clinic until December, 1926, at which time rest in bed was prescribed, and he was told to return January 4, 1927, when the tumor mass was found to measure 10 × 6 cm., and was pulsating forcibly. A diagnosis of thoracic aneurysm was made. On February 13, 1927, the patient experienced a sudden sharp pain on the left side, in the region of the mass, and said he “felt like something bursted inside.” On February 14 he was admitted to the Medical Ward of the hospital, with a chief complaint of “knot on left side, and pain through the heart.” Physical examination showed painful facies; slight clubbing of nails, anemia of mucous membranes, and evident dyspnea, with limited movement of the left chest wall. The right heart border was about 6 cm. from the midsternal line in the fourth interspace.