C. M. COOPER, M.B., M.R.C.S.
JAMA. 1906;XLVI(5):361. doi:10.1001/jama.1906.62510320047003b.
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Epigastric murmurs are well known to be of both intravascular and extravascular origin. Thus any tumors which lie over the artery, e. g., a pyloric or pancreatic carcinoma may press on this vessel and give rise to systolic murmur or to a marked visible localized pulsation. Hence it has become a well-recognized clinical custom to examine patients who present localized pulsations and murmurs of doubtful origin in the knee-chest position. I wish, however, to report a case in which localized pulsation which was actually expansile, together with a systolic bruit, were present in the epigastric region, these signs being due to a distended, displaced gall bladder. The key to the diagnosis lay in the disappearance and reappearance of these signs coincident with the partial emptying and refilling of the cystic swelling. Operation demonstrated the mesial position of the gall bladder. After operation the murmur disappeared, and an autopsy some months


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