Book - An Atlas of Topographical Anatomy 11: Difference between revisions
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=XI. Transverse section of the same body at the level of the bulbus aortse and sixth dorsal vertebra= | |||
{{Braune 1877 header}} | {{Braune 1877 header}} | ||
THIS plate represents the upper surface of a lamina about an inch and a half thick, which was cut by a section passing through the trunk immediately beneath the sternal end of the second rib and the upper border of the sixth dorsal vertebra ; the saw passed out through the fat of the axilla, dividing the humerus at the insertion of the teres major. | |||
Attached to the bone are the tendinous insertions of the great pectoral muscles, and on account of the position of the arms as regards the trunk they are so disposed as to exhibit a flat upward curve, and have been twice cut. Under the tendon of the pectoralis major lie the biceps and coraco-brachialis, and close under the last-named muscle are the vessels and nerves. The axillary artery is surrounded by the plexus, and is found next the muscle. The fascia of the coraco-brachialis must be divided to ligature this artery (after the arm has been raised), and the vessel should be reached from the sheath of the muscle, which can be easily drawn outwards; thus there will be little risk of pinching up and wounding the nerves and veins. Those portions of the trunk which are divided in the second intercostal space are of very great importance. The section of the great vessels passes immediately over their valves, and the left auricle with the upper wall of the auricular appendix are shown. The left auricular appendix lies more deeply, and is seen in front of the .ascending aorta. | Attached to the bone are the tendinous insertions of the great pectoral muscles, and on account of the position of the arms as regards the trunk they are so disposed as to exhibit a flat upward curve, and have been twice cut. Under the tendon of the pectoralis major lie the biceps and coraco-brachialis, and close under the last-named muscle are the vessels and nerves. The axillary artery is surrounded by the plexus, and is found next the muscle. The fascia of the coraco-brachialis must be divided to ligature this artery (after the arm has been raised), and the vessel should be reached from the sheath of the muscle, which can be easily drawn outwards; thus there will be little risk of pinching up and wounding the nerves and veins. Those portions of the trunk which are divided in the second intercostal space are of very great importance. The section of the great vessels passes immediately over their valves, and the left auricle with the upper wall of the auricular appendix are shown. The left auricular appendix lies more deeply, and is seen in front of the .ascending aorta. | ||
Immediately behind the sternum the lungs and pleura3 approximate each other so closely, that only a very small interspace remains. This narrow space leads from the anterior mediastinum to the region of the thymus gland; a sagittal section in the mesial plane in this body must have opened the right pleural cavity. | Immediately behind the sternum the lungs and pleura3 approximate each other so closely, that only a very small interspace remains. This narrow space leads from the anterior mediastinum to the region of the thymus gland; a sagittal section in the mesial plane in this body must have opened the right pleural cavity. | ||
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The contour of the pericardium is clearly shown; it extends at this level considerably further back on the left side than on the right, corresponding with the higher position of the left auricular appendix. On the right side it has been opened in front of the superior vena cava, and extends between it and the aorta posteriorly to the right branch of the pulmonary artery, playing the part of a bursa by permitting the necessary movement of these vessels upon each other. As the trunks of the vessels which pass from the lung into the left auricle, and from the right ventricle to the lung, run horizontally, a section which passes through the roots of the lungs exposes much more of their length, whilst the vessels of the greater circulation, which pass more vertically to and from the heart, appear divided more transversely. The pulmonary artery is the most important to examine of the vessels of the lesser circulation, as it is exposed for a large portion of its course. It is met with close to its origin, and its right branch is divided throughout its course. The left branch does not lie in the same plane, but it is also divided. It rises up somewhat in its course to the left lung, arching over the left bronchus and left auricle. The trunk of the pulmonary artery runs somewhat to the left, backwards and upwards, and can be seen in the upper surface of the section. | The contour of the pericardium is clearly shown; it extends at this level considerably further back on the left side than on the right, corresponding with the higher position of the left auricular appendix. On the right side it has been opened in front of the superior vena cava, and extends between it and the aorta posteriorly to the right branch of the pulmonary artery, playing the part of a bursa by permitting the necessary movement of these vessels upon each other. As the trunks of the vessels which pass from the lung into the left auricle, and from the right ventricle to the lung, run horizontally, a section which passes through the roots of the lungs exposes much more of their length, whilst the vessels of the greater circulation, which pass more vertically to and from the heart, appear divided more transversely. The pulmonary artery is the most important to examine of the vessels of the lesser circulation, as it is exposed for a large portion of its course. It is met with close to its origin, and its right branch is divided throughout its course. The left branch does not lie in the same plane, but it is also divided. It rises up somewhat in its course to the left lung, arching over the left bronchus and left auricle. The trunk of the pulmonary artery runs somewhat to the left, backwards and upwards, and can be seen in the upper surface of the section. | ||
It is evident that the aorta and pulmonary artery are fixed together, whilst the former is capable of movement upon the vena cava. The relation of the aorta to the right pulmonary artery is important, as in aneurismal dilatations of the first part of the aorta compression of the right pulmonary artery may be expected. The position of the valves of the pulmonary artery and aorta with regard to the chest wall were accurately defined in the preparation, and can be deduced approximately from the plate. The pulmonary orifice lay behind the left border of the sternum under the upper margin of the third costal cartilage. The aortic orifice lay behind the left half of the sternum on a level with the third costal cartilage, behind and to the right of the pulmonary opening. The curvature of the aorta behind the first part of the pulmonary artery, with the position of its valves, is rendered as accurately as possible. It must however be expressly understood that such definitions cannot represent with absolute accuracy the relations on the living body. Apart from the influence which maintains the filling of the vessels, the position of the heart and its great branches is determined chiefly by the lungs and diaphragm, and it varies with each change of position of these important connexions. (This will be referred to again in the text accompanying the next plate.) Both bronchi are clearly seen ; the left is divided more obliquely, in consequence of its being less vertical than the right, and as its ramifications lie in the plane of section, more of its branches are seen; whilst as the right has been divided more transversely, most of its branches have been separated. Between them, at the root of the lung, are a number of the characteristic pigmented bronchial glands. | It is evident that the aorta and pulmonary artery are fixed together, whilst the former is capable of movement upon the vena cava. The relation of the aorta to the right pulmonary artery is important, as in aneurismal dilatations of the first part of the aorta compression of the right pulmonary artery may be expected. The position of the valves of the pulmonary artery and aorta with regard to the chest wall were accurately defined in the preparation, and can be deduced approximately from the plate. The pulmonary orifice lay behind the left border of the sternum under the upper margin of the third costal cartilage. The aortic orifice lay behind the left half of the sternum on a level with the third costal cartilage, behind and to the right of the pulmonary opening. The curvature of the aorta behind the first part of the pulmonary artery, with the position of its valves, is rendered as accurately as possible. It must however be expressly understood that such definitions cannot represent with absolute accuracy the relations on the living body. Apart from the influence which maintains the filling of the vessels, the position of the heart and its great branches is determined chiefly by the lungs and diaphragm, and it varies with each change of position of these important connexions. (This will be referred to again in the text accompanying the next plate.) Both bronchi are clearly seen ; the left is divided more obliquely, in consequence of its being less vertical than the right, and as its ramifications lie in the plane of section, more of its branches are seen; whilst as the right has been divided more transversely, most of its branches have been separated. Between them, at the root of the lung, are a number of the characteristic pigmented bronchial glands. | ||
Nearly in the centre, in front of the sixth dorsal vertebra, is the oesophagus, and behind it, to the left side, is the descending aorta, which already begins to take a direction towards the middle line. Between the oesophagus and the aorta is the thoracic duct, which in this instance is double. The vagus lies on the right side near the oesophagus and the vena azygos major; on the left side it lies between the bronchus and descending aorta. | Nearly in the centre, in front of the sixth dorsal vertebra, is the oesophagus, and behind it, to the left side, is the descending aorta, which already begins to take a direction towards the middle line. Between the oesophagus and the aorta is the thoracic duct, which in this instance is double. The vagus lies on the right side near the oesophagus and the vena azygos major; on the left side it lies between the bronchus and descending aorta. | ||
The practical physician will notice with interest the changes which pathological conditions have given rise to in these sections. I have, therefore, introduced two plates from Pirogoff, which have been taken from the bodies of patients. Fig. 1, taken at the same level as my plate, shows extensive pericardial exudation. | The practical physician will notice with interest the changes which pathological conditions have given rise to in these sections. I have, therefore, introduced two plates from Pirogoff, which have been taken from the bodies of patients. Fig. 1, taken at the same level as my plate, shows extensive pericardial exudation. | ||
The immense expansion which the pericardium has attained at the roots of the great blood-vessels is remarkable ; both pleural sacs are widely drawn asunder, and the right especially has acquired a considerable inflexion. The pulmonary artery with its right branch has slightly changed its position with regard to the middle line ; the aorta lies considerably further towards the right side than is normal, and is pushed far away from the vena cava. On account of the exudation all the vessels seem to be pushed towards the vertebral column. | The immense expansion which the pericardium has attained at the roots of the great blood-vessels is remarkable ; both pleural sacs are widely drawn asunder, and the right especially has acquired a considerable inflexion. The pulmonary artery with its right branch has slightly changed its position with regard to the middle line ; the aorta lies considerably further towards the right side than is normal, and is pushed far away from the vena cava. On account of the exudation all the vessels seem to be pushed towards the vertebral column. | ||
The section corresponds with that given by Pirogoff (fasc. ii, p. 22), and passes through the second intercostal space, dividing the third, fourth, and fifth ribs of both sides and the fourth costal cartilage at the level of its upper margin. The age of the man, who had lain in hospital a long time, is not clearly denned, and is as of middle life. In any case the age was greater than that of my subject. It is remarkable that, although in the region of the sternum both sections began almost exactly at the same level, they struck different vertebrae; in PirogofTs case the fourth, in mine the sixth. As the definition of the position of the heart with regard to the bones of the anterior wall of the chest is of clinical importance, I have, in spite of the difference of the vertebrae of Pirogoff's plate, chosen it for the sake of the comparison, as the section happens to pass through the same intercostal space as mine. | The section corresponds with that given by Pirogoff (fasc. ii, p. 22), and passes through the second intercostal space, dividing the third, fourth, and fifth ribs of both sides and the fourth costal cartilage at the level of its upper margin. The age of the man, who had lain in hospital a long time, is not clearly denned, and is as of middle life. In any case the age was greater than that of my subject. It is remarkable that, although in the region of the sternum both sections began almost exactly at the same level, they struck different vertebrae; in PirogofTs case the fourth, in mine the sixth. As the definition of the position of the heart with regard to the bones of the anterior wall of the chest is of clinical importance, I have, in spite of the difference of the vertebrae of Pirogoff's plate, chosen it for the sake of the comparison, as the section happens to pass through the same intercostal space as mine. | ||
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It must be borne in mind that owing to the exudation into the pericardial and pleural cavities in Pirogoff 's subject, the ribs are raised and their anterior extremities lie two vertebras higher than in my case. | It must be borne in mind that owing to the exudation into the pericardial and pleural cavities in Pirogoff 's subject, the ribs are raised and their anterior extremities lie two vertebras higher than in my case. | ||
The following woodcut, Fig. 2, shows the variation in the position of the parts of a similar section in pleuritic effusion of the left side with pneumo-thorax. The subject is the same as in Fig. 2 of the text of Plate X. The expansion of the left side of the thorax, and the lateral displacement of the great vessels, can be clearly made out. | The following woodcut, Fig. 2, shows the variation in the position of the parts of a similar section in pleuritic effusion of the left side with pneumo-thorax. The subject is the same as in Fig. 2 of the text of Plate X. The expansion of the left side of the thorax, and the lateral displacement of the great vessels, can be clearly made out. | ||
The commencement of the pulmonary artery lies behind the right border of the sternum, and that of the aorta behind the third costal cartilage. | The commencement of the pulmonary artery lies behind the right border of the sternum, and that of the aorta behind the third costal cartilage. | ||
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Pirogoff 's section (cf . text to plate, ' Atlas,' fasc. ii, p. 28) runs horizontally through the upper border of the third- costal cartilage, dividing the third, fourth, and fifth ribs of both sides ; it passes also through the upper border of the fifth dorsal vertebra. Here the section passes a vertebra higher than in my case; this resulted from the expansion of the thorax, and the position of the ribs consequent on inspiration. It is remarkable that both right and left sides of the thorax are equally raised, so that they show a closely symmetrical division of the ribs. Besides the local pleuritic adhesion, which stretches like a cord from the inner surface of the ribs to the lung, there are other and wider bands which divide the pleural cavity into three portions. The left lung is, moreover, very much compressed and adherent to the costal pleura, so that its section appears polygonal. | Pirogoff 's section (cf . text to plate, ' Atlas,' fasc. ii, p. 28) runs horizontally through the upper border of the third- costal cartilage, dividing the third, fourth, and fifth ribs of both sides ; it passes also through the upper border of the fifth dorsal vertebra. Here the section passes a vertebra higher than in my case; this resulted from the expansion of the thorax, and the position of the ribs consequent on inspiration. It is remarkable that both right and left sides of the thorax are equally raised, so that they show a closely symmetrical division of the ribs. Besides the local pleuritic adhesion, which stretches like a cord from the inner surface of the ribs to the lung, there are other and wider bands which divide the pleural cavity into three portions. The left lung is, moreover, very much compressed and adherent to the costal pleura, so that its section appears polygonal. | ||
As the normal relations of the thoracic organs have been exhaustively treated of by Luschka, Henle, Meyer, and others, I must refer the reader to their works, and proceed with a description of certain results of observations on dislocation of the heart from collections of fluid in the pleural cavities. | As the normal relations of the thoracic organs have been exhaustively treated of by Luschka, Henle, Meyer, and others, I must refer the reader to their works, and proceed with a description of certain results of observations on dislocation of the heart from collections of fluid in the pleural cavities. | ||
Fig. 3 shows the normal relations of the heart to the anterior wall of the chest, as determined from numerous examinations which I have made on young male subjects. After injecting the heart, and using only moderate pressure, the left auricular appendix became more visible than is usually the case when it is empty. | Fig. 3 shows the normal relations of the heart to the anterior wall of the chest, as determined from numerous examinations which I have made on young male subjects. After injecting the heart, and using only moderate pressure, the left auricular appendix became more visible than is usually the case when it is empty. | ||
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Fig. 4 represents a very considerable dislocation of the heart to the right side, produced by pleuritic effusion. The body lying on the back, the heart was fixed to the anterior and posterior walls of the thorax by six long needles, and the position of each portion accurately defined with regard to the anterior wall of the chest. It will be observed that the dislocation of the heart is considerably greater as regards its apex than its base, and that at the same time a rotation towards the right side on the long axis has taken place, so that a greater projection of the left ventricle has resulted. The vertical position of the heart's axis in this instance was determined by exact measurement. | Fig. 4 represents a very considerable dislocation of the heart to the right side, produced by pleuritic effusion. The body lying on the back, the heart was fixed to the anterior and posterior walls of the thorax by six long needles, and the position of each portion accurately defined with regard to the anterior wall of the chest. It will be observed that the dislocation of the heart is considerably greater as regards its apex than its base, and that at the same time a rotation towards the right side on the long axis has taken place, so that a greater projection of the left ventricle has resulted. The vertical position of the heart's axis in this instance was determined by exact measurement. | ||
The following woodcuts (5 and 6) also show dislocation of the heart from effusion into the pleural cavities. They are, however, the results of experiments which were made by myself on fresh normal bodies. | The following woodcuts (5 and 6) also show dislocation of the heart from effusion into the pleural cavities. They are, however, the results of experiments which were made by myself on fresh normal bodies. | ||
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The bodies were placed in the upright position and care was taken that the tracheae remained open, and that the other parts were in their normal positions, and disregarding any experiment which did not seem to be complete, the conditions shown in the accompanying woodcuts were obtained. | The bodies were placed in the upright position and care was taken that the tracheae remained open, and that the other parts were in their normal positions, and disregarding any experiment which did not seem to be complete, the conditions shown in the accompanying woodcuts were obtained. | ||
After finishing the experiments by injecting a weak solution of common salt, the trachea was closed, so that on opening the thorax any farther falling together of the lungs should be impossible. The heart was fixed to the anterior and posterior walls of the thorax, with long needles, and the intercostal spaces subsequently opened, in order to determine the position of the heart with regard to the framework of the chest. It was found that the apex of the heart was pushed considerably backwards ; and so also was the base, although strengthened by the great vessels forming the root of the lung. There was lateral rotation of the heart on its long axis. The quantity of fluid injected in fig. 5 was five, and in fig. 6 six pounds. It was observed that after the introduction of a pound and a half of fluid, there was an evident increase of dulness on percussion in the region of the liver (corresponding with the observations of Seitz and Zamminer). | After finishing the experiments by injecting a weak solution of common salt, the trachea was closed, so that on opening the thorax any farther falling together of the lungs should be impossible. The heart was fixed to the anterior and posterior walls of the thorax, with long needles, and the intercostal spaces subsequently opened, in order to determine the position of the heart with regard to the framework of the chest. It was found that the apex of the heart was pushed considerably backwards ; and so also was the base, although strengthened by the great vessels forming the root of the lung. There was lateral rotation of the heart on its long axis. The quantity of fluid injected in fig. 5 was five, and in fig. 6 six pounds. It was observed that after the introduction of a pound and a half of fluid, there was an evident increase of dulness on percussion in the region of the liver (corresponding with the observations of Seitz and Zamminer). | ||
As bearing on these experiments, I examined Pirogoff's plates relating to the sections of a subject with empyema of the right side and dislocation of the heart. (The section had been made after freezing.) I also collected material from the same author, of a body with pneumo-thorax of the left side. | As bearing on these experiments, I examined Pirogoff's plates relating to the sections of a subject with empyema of the right side and dislocation of the heart. (The section had been made after freezing.) I also collected material from the same author, of a body with pneumo-thorax of the left side. | ||
After careful measurements on the different plates, the contours of the dislocated heart were constructed and shown in figs. 5 and 6 by the dotted lines, so that a comparison with the results of my own researches might be instituted. | After careful measurements on the different plates, the contours of the dislocated heart were constructed and shown in figs. 5 and 6 by the dotted lines, so that a comparison with the results of my own researches might be instituted. | ||
In PirogofFs definitions of the heart's position, exact as they are, the quantity of the morbid fluid could not have been measured, and one cannot expect that a dislocation of the heart could be expressed by a surface of the contours. Moreover, an artificial effusion into the pleural cavity could never produce the same relations as a gradually increasing exudation. But it follows certainly from these instances, and it is even proved by the difference of methods, that in dislocations such as these, the base of the heart does not remain fixed, but that it is considerably moved from its place (and the apex likewise), and that there is a rotation of the heart on its long axis. | In PirogofFs definitions of the heart's position, exact as they are, the quantity of the morbid fluid could not have been measured, and one cannot expect that a dislocation of the heart could be expressed by a surface of the contours. Moreover, an artificial effusion into the pleural cavity could never produce the same relations as a gradually increasing exudation. But it follows certainly from these instances, and it is even proved by the difference of methods, that in dislocations such as these, the base of the heart does not remain fixed, but that it is considerably moved from its place (and the apex likewise), and that there is a rotation of the heart on its long axis. | ||
{{Braune 1877 footer}} | |||
Latest revision as of 20:23, 31 October 2012
XI. Transverse section of the same body at the level of the bulbus aortse and sixth dorsal vertebra
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Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.
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THIS plate represents the upper surface of a lamina about an inch and a half thick, which was cut by a section passing through the trunk immediately beneath the sternal end of the second rib and the upper border of the sixth dorsal vertebra ; the saw passed out through the fat of the axilla, dividing the humerus at the insertion of the teres major.
Attached to the bone are the tendinous insertions of the great pectoral muscles, and on account of the position of the arms as regards the trunk they are so disposed as to exhibit a flat upward curve, and have been twice cut. Under the tendon of the pectoralis major lie the biceps and coraco-brachialis, and close under the last-named muscle are the vessels and nerves. The axillary artery is surrounded by the plexus, and is found next the muscle. The fascia of the coraco-brachialis must be divided to ligature this artery (after the arm has been raised), and the vessel should be reached from the sheath of the muscle, which can be easily drawn outwards; thus there will be little risk of pinching up and wounding the nerves and veins. Those portions of the trunk which are divided in the second intercostal space are of very great importance. The section of the great vessels passes immediately over their valves, and the left auricle with the upper wall of the auricular appendix are shown. The left auricular appendix lies more deeply, and is seen in front of the .ascending aorta.
Immediately behind the sternum the lungs and pleura3 approximate each other so closely, that only a very small interspace remains. This narrow space leads from the anterior mediastinum to the region of the thymus gland; a sagittal section in the mesial plane in this body must have opened the right pleural cavity.
The contour of the pericardium is clearly shown; it extends at this level considerably further back on the left side than on the right, corresponding with the higher position of the left auricular appendix. On the right side it has been opened in front of the superior vena cava, and extends between it and the aorta posteriorly to the right branch of the pulmonary artery, playing the part of a bursa by permitting the necessary movement of these vessels upon each other. As the trunks of the vessels which pass from the lung into the left auricle, and from the right ventricle to the lung, run horizontally, a section which passes through the roots of the lungs exposes much more of their length, whilst the vessels of the greater circulation, which pass more vertically to and from the heart, appear divided more transversely. The pulmonary artery is the most important to examine of the vessels of the lesser circulation, as it is exposed for a large portion of its course. It is met with close to its origin, and its right branch is divided throughout its course. The left branch does not lie in the same plane, but it is also divided. It rises up somewhat in its course to the left lung, arching over the left bronchus and left auricle. The trunk of the pulmonary artery runs somewhat to the left, backwards and upwards, and can be seen in the upper surface of the section.
It is evident that the aorta and pulmonary artery are fixed together, whilst the former is capable of movement upon the vena cava. The relation of the aorta to the right pulmonary artery is important, as in aneurismal dilatations of the first part of the aorta compression of the right pulmonary artery may be expected. The position of the valves of the pulmonary artery and aorta with regard to the chest wall were accurately defined in the preparation, and can be deduced approximately from the plate. The pulmonary orifice lay behind the left border of the sternum under the upper margin of the third costal cartilage. The aortic orifice lay behind the left half of the sternum on a level with the third costal cartilage, behind and to the right of the pulmonary opening. The curvature of the aorta behind the first part of the pulmonary artery, with the position of its valves, is rendered as accurately as possible. It must however be expressly understood that such definitions cannot represent with absolute accuracy the relations on the living body. Apart from the influence which maintains the filling of the vessels, the position of the heart and its great branches is determined chiefly by the lungs and diaphragm, and it varies with each change of position of these important connexions. (This will be referred to again in the text accompanying the next plate.) Both bronchi are clearly seen ; the left is divided more obliquely, in consequence of its being less vertical than the right, and as its ramifications lie in the plane of section, more of its branches are seen; whilst as the right has been divided more transversely, most of its branches have been separated. Between them, at the root of the lung, are a number of the characteristic pigmented bronchial glands.
Nearly in the centre, in front of the sixth dorsal vertebra, is the oesophagus, and behind it, to the left side, is the descending aorta, which already begins to take a direction towards the middle line. Between the oesophagus and the aorta is the thoracic duct, which in this instance is double. The vagus lies on the right side near the oesophagus and the vena azygos major; on the left side it lies between the bronchus and descending aorta.
The practical physician will notice with interest the changes which pathological conditions have given rise to in these sections. I have, therefore, introduced two plates from Pirogoff, which have been taken from the bodies of patients. Fig. 1, taken at the same level as my plate, shows extensive pericardial exudation.
The immense expansion which the pericardium has attained at the roots of the great blood-vessels is remarkable ; both pleural sacs are widely drawn asunder, and the right especially has acquired a considerable inflexion. The pulmonary artery with its right branch has slightly changed its position with regard to the middle line ; the aorta lies considerably further towards the right side than is normal, and is pushed far away from the vena cava. On account of the exudation all the vessels seem to be pushed towards the vertebral column.
The section corresponds with that given by Pirogoff (fasc. ii, p. 22), and passes through the second intercostal space, dividing the third, fourth, and fifth ribs of both sides and the fourth costal cartilage at the level of its upper margin. The age of the man, who had lain in hospital a long time, is not clearly denned, and is as of middle life. In any case the age was greater than that of my subject. It is remarkable that, although in the region of the sternum both sections began almost exactly at the same level, they struck different vertebrae; in PirogofTs case the fourth, in mine the sixth. As the definition of the position of the heart with regard to the bones of the anterior wall of the chest is of clinical importance, I have, in spite of the difference of the vertebrae of Pirogoff's plate, chosen it for the sake of the comparison, as the section happens to pass through the same intercostal space as mine.
FIG. 1. Adult male thorax. Hydro-pericarditis. Insufficiency of aortic valves. Pleurisy.
Pirogoff, ii, p. 1, .
1. Bronchi. 2. (Esophagus. 3. Pulmonary artery. 4. Ascending aorta. 5. Superior vena cava. 6. Descending aorta.
It must be borne in mind that owing to the exudation into the pericardial and pleural cavities in Pirogoff 's subject, the ribs are raised and their anterior extremities lie two vertebras higher than in my case.
The following woodcut, Fig. 2, shows the variation in the position of the parts of a similar section in pleuritic effusion of the left side with pneumo-thorax. The subject is the same as in Fig. 2 of the text of Plate X. The expansion of the left side of the thorax, and the lateral displacement of the great vessels, can be clearly made out.
The commencement of the pulmonary artery lies behind the right border of the sternum, and that of the aorta behind the third costal cartilage.
FIG. 2. Subject C. Adult male thorax. Left lateral pneumo- thorax. Pirogoff, ii, 7, 3, 5.
1. Bronchi. 2. (Esophagus. 3. Pulmonary artery. 4. Ascending aorta. 5. Superior vena cava. 6. Descending aorta.
Pirogoff 's section (cf . text to plate, ' Atlas,' fasc. ii, p. 28) runs horizontally through the upper border of the third- costal cartilage, dividing the third, fourth, and fifth ribs of both sides ; it passes also through the upper border of the fifth dorsal vertebra. Here the section passes a vertebra higher than in my case; this resulted from the expansion of the thorax, and the position of the ribs consequent on inspiration. It is remarkable that both right and left sides of the thorax are equally raised, so that they show a closely symmetrical division of the ribs. Besides the local pleuritic adhesion, which stretches like a cord from the inner surface of the ribs to the lung, there are other and wider bands which divide the pleural cavity into three portions. The left lung is, moreover, very much compressed and adherent to the costal pleura, so that its section appears polygonal.
As the normal relations of the thoracic organs have been exhaustively treated of by Luschka, Henle, Meyer, and others, I must refer the reader to their works, and proceed with a description of certain results of observations on dislocation of the heart from collections of fluid in the pleural cavities.
Fig. 3 shows the normal relations of the heart to the anterior wall of the chest, as determined from numerous examinations which I have made on young male subjects. After injecting the heart, and using only moderate pressure, the left auricular appendix became more visible than is usually the case when it is empty.
FIG. 3. Normal position of the heart.
FIG. 4. Dislocation of the heart. Pleuritic exudation on the left side, .
Fig. 4 represents a very considerable dislocation of the heart to the right side, produced by pleuritic effusion. The body lying on the back, the heart was fixed to the anterior and posterior walls of the thorax by six long needles, and the position of each portion accurately defined with regard to the anterior wall of the chest. It will be observed that the dislocation of the heart is considerably greater as regards its apex than its base, and that at the same time a rotation towards the right side on the long axis has taken place, so that a greater projection of the left ventricle has resulted. The vertical position of the heart's axis in this instance was determined by exact measurement.
The following woodcuts (5 and 6) also show dislocation of the heart from effusion into the pleural cavities. They are, however, the results of experiments which were made by myself on fresh normal bodies.
FIG. 5. Left lateral hydrothorax, artificial, ^th.
FIG. 6. Right lateral hydrothorax, artificial, ^th.
The bodies were placed in the upright position and care was taken that the tracheae remained open, and that the other parts were in their normal positions, and disregarding any experiment which did not seem to be complete, the conditions shown in the accompanying woodcuts were obtained.
After finishing the experiments by injecting a weak solution of common salt, the trachea was closed, so that on opening the thorax any farther falling together of the lungs should be impossible. The heart was fixed to the anterior and posterior walls of the thorax, with long needles, and the intercostal spaces subsequently opened, in order to determine the position of the heart with regard to the framework of the chest. It was found that the apex of the heart was pushed considerably backwards ; and so also was the base, although strengthened by the great vessels forming the root of the lung. There was lateral rotation of the heart on its long axis. The quantity of fluid injected in fig. 5 was five, and in fig. 6 six pounds. It was observed that after the introduction of a pound and a half of fluid, there was an evident increase of dulness on percussion in the region of the liver (corresponding with the observations of Seitz and Zamminer).
As bearing on these experiments, I examined Pirogoff's plates relating to the sections of a subject with empyema of the right side and dislocation of the heart. (The section had been made after freezing.) I also collected material from the same author, of a body with pneumo-thorax of the left side.
After careful measurements on the different plates, the contours of the dislocated heart were constructed and shown in figs. 5 and 6 by the dotted lines, so that a comparison with the results of my own researches might be instituted.
In PirogofFs definitions of the heart's position, exact as they are, the quantity of the morbid fluid could not have been measured, and one cannot expect that a dislocation of the heart could be expressed by a surface of the contours. Moreover, an artificial effusion into the pleural cavity could never produce the same relations as a gradually increasing exudation. But it follows certainly from these instances, and it is even proved by the difference of methods, that in dislocations such as these, the base of the heart does not remain fixed, but that it is considerably moved from its place (and the apex likewise), and that there is a rotation of the heart on its long axis.
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- Braune Plates (1877): 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term
Reference
Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.
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Cite this page: Hill, M.A. (2024, April 25) Embryology Book - An Atlas of Topographical Anatomy 11. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_11
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