In cavernous growths of the thyroid are vessels, veins especially, the size of the thumb, while with the ear not touching the body of the patient a distinct venous murmur may be heard.
3. Arterial or Plexiform Angiomas.
—Arterial or plexiform angiomas, when of any particular size, are called cirsoid aneurysm or aneurysm by anastomosis. This form consists of arteries abnormal both in number, length, and diameter, tortuous in arrangement, occurring often in the scalp, but rarely in the perineum or genitalia, and seldom in other parts of the body. (See [Aneurysm], [Chapter XXIX].) These tumors are liable to rupture from external injury, and necessitate ligation of the main arterial trunks, with perhaps extirpation of the tumor mass.
Recognition of angiomas is not difficult unless they are deeply concealed. The effect of intermitting pressure, the emptying and refilling, and the distinction between arterial and venous growths by the result of alternating pressure and relaxation, either above or below the growth, with discoloration of the skin, and, in the larger growths, audible murmur, leave little doubt of the character of the growth.
When such growths are small they may be dealt with by electrolysis, the needles from both poles being introduced, or that from the negative, the positive being applied upon some neighboring portion of the body. The effect of the electric current is to determine coagulation of the blood in the tissues acted upon, and this is followed by organization of thrombus, conversion of vascular into cicatricial tissue, shrinkage, and possible eventual disappearance of the mass. Radical excision under an anesthetic should be made, dissecting out the mass, securing bleeding vessels, and reuniting the parts by sutures, with the expectation of securing primary union. This is the quickest and in many cases the least disfiguring method. Old methods of ligation of surrounding vessels or the subcutaneous ligature are now practically discarded. The injection methods as formerly practised, especially the use of iron salts in solution, are severely condemned, as death is liable to occur. With electrolysis and excision the surgeon has nearly all the measures which he will need to practise for the medical treatment of angiomas.
Fig. 81
Lymphangioma of lip; macrocheilia. (Neisser.)
Lymphangioma.
—Lymphangiomas are tumors composed of lymph vessels and bear resemblance to the tumors above considered. They may be divided into three varieties: