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October 1, 1932


JAMA. 1932;99(14):1165-1166. doi:10.1001/jama.1932.27410660001010

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A Portuguese, aged 60, seen in March, 1930, complained of cough only. On examination he presented the classic syndrome of aneurysm of the arch, except for the absence of murmur or bruit. There was brassy cough, hoarseness and tracheal tug. Roentgen examination showed an aneurysm. The blood pressure was 160 systolic and 100 diastolic. The Wassermann reaction was ++++, the Kahn reaction +. The urine was normal. There was moderate dyspnea on exertion. He received antisyphilitic treatment, iodides and bismuth compounds only.

He remained at home as a semi-invalid until death. He had periodic attacks of pain and dyspnea, which were relieved by codeine. Roentgenograms from time to time showed slow increase in the size of the aneurysm.

During the night of April 20, 1932, he had an unusually severe attack of pain and dyspnea which did not respond to codeine. He was seen at 3 p. m., April 20. There was

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