Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The pulmonary artery, B, Plates 1 & 2, lies close upon the fore part,
and conceals the origin, of the systemic aorta. Whenever, therefore, the
semilunar valves of either the pulmonary artery or the systemic aorta
become diseased, it must be extremely difficult to distinguish by the
sounds alone, during life, in which of the two the derangement exists.
The origins of both vessels being at the fore part of the chest, it is
in this situation, of course, that the state of their valves is to be
examined. The descending part of the thoracic aorta, G*, being at the
posterior part of the chest, and lying on the vertebral ends of the left
thoracic ribs, will therefore require that we should examine its
condition in the living body at the dorsal aspect of the thorax. As the
arch of the aorta is directed from before backwards--that is, from the
sternum to the spine, it follows that when an aneurism implicates this
region of the vessel, the exact situation of the tumour must be
determined by antero-posterior examination; and we should recollect,
that though on the fore part of the chest the cartilages of the second
ribs, where these join the sternum, mark the level of the aortic arch,
on the back of the chest its level is to be taken from the vertebral
ends of the third or fourth ribs. This difference is caused by the
oblique descent of the ribs from the spine to the sternum. The first and
second dorsal vertebrae, with which the first and second ribs
articulate, are considerably above the level of the first and second
pieces of the sternum.
In a practical point of view, the pulmonary artery possesses but small
interest for us; and in truth the trunk of the systemic aorta itself may
be regarded in the same disheartening consideration, forasmuch as when
serious disease attacks either vessel, the "tree of life" may be said to
be lopped at its root.
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