CASE HISTORY

The patient was picked up unconscious outside the hospital and was found to be dead on arrival in the casualty Department.  No history was obtainable. 

PATHOLOGY

The specimen consists of a part of the heart, together with the thoracic aorta. The right and left ventricles were of normal size and there was no sign of hypertrophy or dilation. The two coronary arteries show some atheroma but are not significantly obstructed. The tricuspid and mitral valves are normal. The pulmonary valve and artery have been removed. The aorta has been opened to show the aortic valve and this is healthy, and competent. The first part of the aorta is a little dilated and shows a few wrinkled scars. Above this and at the beginning of the arch, there is a moderate amount of atheroma overlying puckered scars. The top of the arch of the aorta is relatively healthy. The first part of the descending thoracic aorta shows a saccular aneurism bulging to the right. The intima is extremely rough and irregular due to a mixture of atheroma and surface thrombi together with the scarring of underlying syphilis. The arrow points to a vertical linear tear and blood has seeped through, spreading along the adventitia and finally has burst through the pleura opposite D.10 and flooded the right pleural cavity with blood. Three litres of blood were found in the right pleural cavity.