—Cirsoid or racemose aneurysms constitute vascular tumors of irregular shape and outline, according to the extent of the arterial system involved.
Fig. 155
Cirsoid aneurysm of femoral artery and telangiectasis, with lengthening of affected limb from hypernutrition. (Parker.)
6. Angioma or Aneurysm by Anastomosis.
—The difference between angiomas and cirsoid aneurysms is more artificial than natural. When a single vessel is involved with all its branches it constitutes an elongated tumor and partakes of the nature of a varix. When the growth is a collection of small arteries the condition is then known as an angioma. Between these there may be all varieties of vascular changes. [Fig. 154] illustrates a case of this kind in the scalp, while [Fig. 155], contributed by Parker, illustrates a congenital involvement of the vessels of an entire limb, with overgrowth of the same from increase of blood supply.
Diagnosis.
—All aneurysm so constituted as to be easily palpated can scarcely be mistaken for a tumor of any other kind. It can be recognized by its circumscribed nature; its pulsation, which is always of the expansile type; its bruit, which is synchronous with systole. It can be emptied by pressure, fills somewhat slowly if pressure is made above it, but more rapidly if pressure is made below it, being in this respect the counterpart of a venous angioma. Its size and rapidity of pulsation are influenced by position, and its location is usually that of one of the large arterial trunks. The murmur, heard through the stethoscope, is sometimes more than a mere bruit, and may be of a tumultuous, almost roaring character, the sounds being modified by the smoothness or roughness of the interior blood channel as well as by the thickness of the parts outside. Naturally the sounds can be altered by pressure. The overlying integument is at first unchanged, but if an aneurysm is working its way toward the surface and threatening rupture the skin will be stretched and discolored and may finally ulcerate. Blood pressure as measured by the sphygmomanometer is not altered in a limb which is affected by aneurysm.
Signs and symptoms which are not local are also produced in most cases, their variety being great and depending upon the location of the primary disturbing cause; for example, there is generally edema with venous congestion of parts situated distally, these features being so extreme in some cases as not only to threaten but even to occasion gangrene. By pressure upon nerves both pain and paralysis are produced and important functions impaired.
The tendency in all aneurysms is to increase in size and cause atrophy or disappearance of the tissues upon which they exercise their present influence.