CASE HISTORY

The patient was admitted form Addenbrook Hospital, Cambridge, with the following history. Patient had been perfectly healthy apart from indigestion several years ago, until one year before admission when she began to suffer from hoarseness, cough and attacks of dyspnoea, she had also suffered from considerable loss of weight, the onset of the hoarseness and cough was comparatively sudden.  She was treated at first as a case of asthma but with no relief.  Five weeks before admission she went into the Addenbrook hospital where she became considerably worse and during the last week she became irrational. Information from Cambridge stated that in the course of five weeks she had had three severe attacks of asthma, radiological evidence of a substernal swelling compressing the trachea and a positive WR.  There was no history of abortions, and patient has two healthy children.  On examination she was extremely ill and completely irrational, she was slightly cyanosed, moderately dyspnoeac with an inspiratory stridor and a harsh metallic cough, eyes shows no abnormality.  Veins of neck, slightly distended.  Thyroid felt rather low down especially on right side where it appears to descend behind the sternum. The trachea is displaced backwards and to the left but there is no tracheal tug.  Signs of BP 90/50 on both sides.  Urine showed a little sugar and acetone.  After admission patient got steadily worse and died. 

PATHOLOGY

The specimen consists of the aortic arch and the trachea. On the posterior aspect of the arch, just behind the origins of the great vessels there is a spherical saccular aneurysm, containing a little laminated clot. The aneurysm has compressed the trachea, narrowing its lumen to a transverse slit, but has not ulcerated the mucosa. The aorta itself is thinned and shows pearly white patches of intimal fibrosis. It was fixed by distending with formalin and consequently does not show the radiating scars characteristic of syphilis. At autopsy the recurrent laryngeal nerve was found to be involved in the fibrosis around the aneurysm.