CASE HISTORY

The patient was admitted as an emergency complaining of severe epigastric pain running up the front of the chest into the neck. There was history of a similar pain five days before admission. On examination, the patient did not appear particularly distressed, but showed a rapid thready pulse of 116. There was no abdominal rigidity or tenderness. A provisional diagnosis of coronary thrombosis was made. Shortly after admission, patient had another attack of pain and died.

PATHOLOGY

Arch of aorta and ventricle – Dissecting aneurysm

The specimen consists of a portion of the anterior wall of the left ventricle together with a half of the adjoining aorta. There is a tear in the wall of the latter just proximal to the origins of the innominate and left common carotid arteries. This tear passes through the intima and media as far as the adventitia. The blood has passed through the tear and has forced its way towards the heart stripping the adventitia off. In parts the line of cleavage lies father in, between the layers of the media. The aneurysm eventually ruptured into the pericardium causing death.