The aorta has been opened from the back to show a saccular aneurysm arising just beyond the
origin of the great vessels. It contains organised blood clot. It is in contact with the left main
bronchus and extends into the lung substance where it is not sharply defined. The aneurysm has
ruptured into the oesophagus.
This man had a ten-day history of increasing fatigue, breathlessness and back pain. He
was anaemic and a CXR showed widening of the mediastinum. He had recently coughed up blood
and was found on admission to have massive gastro-intestinal bleeding.