Case : a large pedunculated thrombus hanging from the wall of the left auricle, associated with mitral stenosis / by John Hay.

  • Hay, John, 1873-1959.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Case : a large pedunculated thrombus hanging from the wall of the left auricle, associated with mitral stenosis / by John Hay. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Eolleston,^ in which the thrombus arising from the fossa ovalis projected through the mitral orifice, and gave rise to the signs of mitral stenosis. Eindfleish^ describes a similar case. Voelcker^ records a case already mentioned similar to mine, in which the throm- bus was attached to the septum ovale, and had the appearance of a champagne cork. Its attachment to the septum ovale was broad, not slender, and the polyp was especially interesting in that it showed signs of vascularisation. The cardiolith described by Sheridan Delepine has been referred to. Poly- poid thrombi are also mentioned by Allan Burns,^ Laennec, Hasse, and Eokitansky. Viewing the case more from the clinical than the pathologi- cal point of view, the presence of the visible auricular pulsation is of extreme interest. Discussion has in the past raged round the question as to whether the left auricle ever reaches the anterior wall of the thorax, or gives rise to a presystolic pulsation. Only so lately as 1897, George W. Balfour, M.D., of Edinburgh,^ stated that it did so “ beyond all possibility of doubt,” whilst G. A. Gibson,® William Eussell,^ and some others are equally emphatic in its denial. Sansom ^ states definitely that in children suffering from mitral stenosis, the left auricle does rarely impinge against the thoracic parietes, giving rise to a pulsation, presystolic in time, which can be seen and felt in the 2nd and 3rd left inter- spaces close to the sternum. He also draws attention to the wavy pulsation one occasion- ally feels in placing the hand over the pr£ecordium, and is of ^ “ Intracardiac Thrombus projecting througli Mitral Orifice,” Ewart and Rolleston, Clinical Soc. Trans. Loncl., vol, xxx. p. 190. Pathological Histology, New Sydenham Soc., 1872, vol. i. p. 295. “ Intra-auricular Cardiac Polyp,” Voelcker, Path. Soc. Trans., xliv. p. 31. ^ Diseases of Heart, 1809. G. W. Balfour, M.U., Journal of Pathol, and Bacteriology, vol. iv., 1897, p. 75. ^ G. A. Gibson, M.D., Journal of Pathol, and Bacteriology, vol. iii., 1894, p. 34. ^ Wm. Russell, M.D., Investigations into some Morbid Cardiac Conditions, Edinburgh, 1886, p. 41. ^ Diagnosis of Diseases of Heart and Thoracic Aorta, 1892. VOL. XX. K