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The progress of natural cure is indicated by the aneurysm becoming smaller, firmer, less expansile, and less compressible; the murmur and thrill diminish and the pressure effects become less marked. While these changes are taking place the collateral arteries become enlarged, and an anastomotic circulation is established.
Tumours of the thyreoid, enlarged lymph glands, and fatty and sarcomatous tumours can usually be distinguished from aneurysm by the history of the swelling and by physical examination. Cystic tumours and abscesses in the neck are sometimes more difficult to differentiate on account of the apparently expansile character of the pulsation transmitted to them.
#Differential Diagnosis.# The diagnosis is to be made from other pulsatile swellings. Pulsation is sometimes transmitted from a large artery to a tumour, a mass of enlarged lymph glands, or an inflammatory swelling which lies in its vicinity, but the pulsation is not expansile a most important point in differential diagnosis.
While any of the large branches in the abdomen may be affected, the most common seats are in the aorta itself, just above the origin of the cœliac artery and at the bifurcation. The clinical features vary with the site of the aneurysm and with its rapidity and direction of growth. A smooth, rounded swelling, which exhibits expansile pulsation, forms, usually towards the left of the middle line.
#Clinical Features of Aneurysm.# Surgically, the sacculated is by far the most important variety. The outstanding feature is the existence in the line of an artery of a globular swelling, which pulsates. The pulsation is of an expansile character, which is detected by observing that when both hands are placed over the swelling they are separated with each beat of the heart.
Vascular tumours, such as sarcoma and goitre, may yield an expansile pulsation and a soft, whifling bruit, but they differ from an aneurysm in that they are not diminished in size by compression of the main artery, nor can they be emptied by pressure. The exaggerated pulsation sometimes observed in the abdominal aorta, the "pulsating aorta" seen in women, should not be mistaken for aneurysm.
When an artery is wounded a firm hæmatoma may form, with an expansile pulsation and a palpable thrill whether such a hæmatoma remains circumscribed or becomes diffuse depends upon the density or laxity of the tissues around it. In course of time a traumatic arterial aneurysm may develop from such a hæmatoma.
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