Fig. 156
Varices of saphenous and branches (phlebectasis). (Lexer.) Compare with [Fig. 153].
Regional Indications.
Innominate Aneurysms.
—Innominate aneurysms usually appear behind the right sternoclavicular joint. As they increase in size they cause pain and edema of the right arm and the right side of the face, cough, dyspnea, and dysphagia. As the swelling increases it rises above the rib and sternum, pushing forward the sternomastoid and the clavicle. After being displaced the bones and cartilages in front begin to disappear by erosion, and the growth makes its way to the surface, where pulsation can be easily seen as well as felt and heard. In proportion to their increase other significant pressure symptoms, with venous turgescence, will occur. Innominate aneurysms can sometimes be differentiated from aortic by the sign, described by Porter, of tracheal tugging. This is elicited by causing the patient to sit up and bend the head forward, after which the cricoid is grasped and drawn forcibly upward, thus stretching the trachea. If with each cardiac impulse a well-marked tugging sensation be felt it may be attributed to the pulsation of an aortic aneurysm.
Subclavian Aneurysms.
—Subclavian aneurysms of the first part of the vessel present similar features, only that the bruit is propagated down the axillary artery rather than up the carotid, and is not influenced by carotid pressure, while the pressure symptoms are limited mostly to the arm. In axillary aneurysm the radial pulse is more delayed.
Carotid Aneurysms.
—Carotid aneurysms are not always easy of early diagnosis, as at the root of the neck solid tumors often transmit a deceiving pulsation and convey an exaggerated vascular sound. They may also give rise to the same pressure symptoms as do subclavian aneurysms. Non-vascular tumors do not have an expansile pulsation, nor is the arterial sound conveyed upward along the carotid as in true aneurysm. In aneurysms of the external carotid there may be paralysis of the tongue as well as difficulties in speech and deglutition. Aneurysms of the internal carotid tend to extend inward rather than outward. Intracranial aneurysms are difficult of diagnosis, but they usually give the symptoms of brain tumor, with possibly a bruit that may be heard and described by the patient himself, especially in certain positions of the head.