23488              DISSECTING ANEURYSM OF THE AORTA

The patient was an 87 year old woman.  Three years before admission she suffered a mild stroke affecting her right upper limb and face and associated with some expressive dysphasia.  She recovered rapidly although mild facial weakness and dysphasia persisted.  She was admitted on the final occasion with a history of light-headedness associated with weakness of the left arm.  There was minimal weakness of the left leg.  She was disorientated and confused.  She was making reasonable progress except for a persistent tachycardia, when she developed a cardiac arrest and died.

The specimen consists of the heart and the aortic arch.  There is a large chronic rent on the anterior and right lateral aspect of the aorta commending 5 cm above the aortic valve and extending to 3 cm beyond the origin of the left subclavian artery.  This rent is filled with antemortem thrombus with lines of Zahn on its surface.  Proximal dissection has occurred to within 2 cm of the aortic valve ring.  The reverse of the specimen shows the chronic haematoma filling the right side of the aortic arch.  A chronic dissection involves the innominate artery on its right side and the lumen of this vessel is greatly compressed.  This may have been the proximate cause of the second stroke involving the left arm and leg.  The acute dissection is present in the left common carotid but the left subclavian artery is unaffected.