76 N.Y. Med. Journ., 1875, xxi.
Cardiac aneurisms rarely produce any symptoms, and in the majority of cases have been found accompanying other conditions which have proved fatal. At the left apex the increase in dulness and area of pulsation could scarcely be distinguished from hypertrophy unless associated with marked bulging. They seldom perforate the chest-wall. Berthold (quoted by Legg) has described one connected with the right auricle which produced a pulsating tumor beneath the skin, the region of the second and third ribs.
Adventitious Products in the Heart.
Tubercle.—In general tuberculosis and in tuberculous pericarditis there may be nodules in the heart-substance, but, as a rule, this organ is very rarely the seat of tubercle. Large caseous masses sometimes occur, but unless associated with tubercle in other organs they are not to be regarded as necessarily tuberculous. Miliary granulations have been seen on the valves.
Cancer and sarcoma rarely are primary, and are not often met with as secondary growths. Sometimes a mediastinal sarcoma penetrates along the veins and involves the auricle, with or without great involvement of the pericardium. The secondary tumors may be single or multiple. In a case of cancer of the uterus I found a large mass in the wall of the right ventricle, involving also the anterior segment of the tricuspid, and partially blocking the orifice. The surface was eroded, and the pulmonary arteries contained numerous cancerous emboli. In another instance the heart was considerably enlarged by the presence of many rounded masses of colloid cancer throughout the walls. In a remarkable case of sudden death in a child I found the tricuspid orifice firmly blocked with a sarcomatous mass which I thought at first had originated in the heart, but dissection showed to have come from the renal vein, which was filled with sarcoma extending from a large tumor of the kidney. Melanotic cancer, fibromata, and myomata have occasionally been seen, and a secondary epithelial growth has been described by Paget.
Syphilis of the heart is met with in the form of gummata or as a specific arteritis leading to patches of fibroid induration. The gummous growths form tumors of variable size, which usually occupy the septum or the ventricles. Possibly many of the caseous and calcified masses not infrequently met represent obsolete gummata. The syphilitic myocarditis probably originates in an affection of the arteries, and leads to patches of fibroid induration more or less extensive. Many authors hold that syphilis plays a very important rôle in the production of fibroid heart.
Cysts.—Simple cysts are rare in the heart. I have met with two instances—one, the size of a marble, situated in the wall of the right auricle near the septum, was filled with a brownish fluid; the other, the size of a small walnut, occupied the base of the posterior segment of the mitral, and was filled with a clear fluid. Blood-cysts occasionally occur.
Parasites.—The Cysticercus cellulosæ, the larva of Tænia solium, and the hydatid or echinococcus, the larva of Tænia echinococcus of the dog, are sometimes found in the heart. The former, usually single, is extremely rare; in the hog and calf the measles, as the cysts are called, very often exist in the heart-muscle. In the recent paper by Mosler77 references are given to 13 cases of cysticerci in the heart. The greatest number present was 19. The hydatid is more common: 25 instances are mentioned in the statistics of Devaine and Cobbold, and Mosler's more recent figures only give 29. They occur in the right ventricle more frequently than in the left. Occasionally they attain a larger size and compress the heart and push back the lungs. The cyst may burst and the contents be discharged into the pulmonary artery or aorta, as in a case given by Osterlen,78 in which gangrene of the right leg followed the plugging of the femoral by hydatid vesicles discharged into the blood by the bursting of a cyst in the left auricle.
77 Zeitschrift für klinische Medicin, Berlin, Bd. vi., 1883.
78 Virchow's Archiv, xlii.