No abstract

In 1939 East was able to find records of only 27 instances in which the diagnosis of dissecting aneurysm had been made during life. Usually death from complete rupture of the aorta quickly follows the initial dissection; of the 300 cases collected by Shennan (1934) 210 died within a week and survival for more than a year was recorded in only 16 cases. We have, therefore, thought it desirable to record two cases in which the diagnosis was made during life; one patient survived for three years and the other is alive and comparatively well eight years after radiographic recognition of the aortic lesion.CASE RECORDS Case 1. In December 1943, a married woman, aged 55, was admitted to the Manchester Royal Infirmary under the care of Dr. Crighton Bramwell, on account of severe pain in the back of the chest and in the lumbar area. Apart from an attack of smallpox when 4 and an operation for uterine prolapse when 41, she enjoyed good health until the age of 52 years. She was then suddenly seized by severe stabbing pain in the left anterior chest which radiated to the left scapular region and the dorso-lumbar area. She fell to the ground but did not lose consciousness. She was confined to bed for two weeks and suffered from some aching pain in the left chest for four or five weeks. Subsequently she remained well for nearly a year, when a similar attack took place; her blood pressure was then found to be 230/130. Following this attack her pain again gradually disappeared and she remained in comparatively good health for a year, when her third attack of severe pain occurred. She was admitted to hospital and the heart and aorta were found t6 be enlarged radiographically. On this occasion, however, her pain did not subsequently disappear, but extended to the lumbar area. After several months of persistent pain in the chest and back she was admitted to the Manchester Royal Infirmary in April 1943, under the care of Dr. Oliver. Her blood pressure was then 210/135 in the right arm and 195/130 in the left. Cardioscopy showed gross dilatation of the aorta. The Wassermann reaction was negative and a diagnosis of chronic dissecting aneurysm was made. She remained in bed for four months, but was never free from pain. When she got up, walking 20 yards brought on severe anginal pain; this gradually improved, but in November 1943 she began to suffer from attacks of palpitation of sudden onset, lasting several hours. She was readmitted under the care of Dr. Bramwell. Her blood pressure was then 225/140 in the left arm and 210/140 in the right. On cardioscopy the aorta was grossly dilated and the left ventricle enlarged ( Fig. 1 and 2). The blood Wassermann and Kahn reactions were negative. A cardiogram showed left axis deviation and biphasic T waves ( +) in leads I and II, with depression of the corresponding RS-T segments; these appearances were attributed to left ventricular strain associated with her hypertension. While in hospital she had several attacks of palpitation, during one of which a cardiogram showed paroxysmal auricular tac...