Venous hums in hepatic cirrhosis.

from Post-mortem Record (Bland-Sutton Institute, No. 228/47). Nothing abnormal was found in the heart, great vessels, or lungs. Blood clots were present in the lumen of the cesophagus, and dilated tortuous veins in the submucosa, extending from the cardia to the level of the aortic arch. A circular perforation, 5 mm. in diameter, was found in a vessel 8 cm. from the cardia. There was no-free fluid in the abdomen. The stomach and intestines were normal. The liver was finely nodular and weighed 1 2 kg.; the microscopic appearances were those of an early coarse cirrhosis. The spleen Was grossly enlarged, weighing nearly 1 kg.; microscopy revealed dilated sinuses, diffuse fibrosis, and siderotic nodules. The inferior vena cava was normal. The portal and splenic veins were much dilated and their walls calcified. A dilated vessel, 1-7 cm. in diameter, was found arising from the left branch of the portal vein. It passed into the falciform ligament and after a distance of 8-7 cm. turned upwards from the free' margin to run tortuously through the linea alba into the superficial tissues of the abdominal wall. The remaining part of the free margin contained the ligamentum teres. The vein appeared just below the tip of the xiphoid and, passing anteriorly'to the process, widened to forma thin-walled sinus 18 mm. in diameter. The sinus united with the dilated left and right internal mammary veins which ran a normal course beneath the phest wall (Fig. 2). 344 group.bmj.com on October 30, 2017 Published by http://heart.bmj.com/ Downloaded from