The heart is normal in size and the aortic and tricuspid valve cusps appear normal. On the posterior
cusp of the mitral valve there is a large haemorrhagic fungating nodule with perforation of the
underlying cusp. The valve otherwise appears normal.
This woman presented at the age of 74 with a six-day history of severe pain of sudden
onset. She developed renal failure and septicaemia and died some four days later. At autopsy a
retroperitoneal abscess was found related to the anterolateral surface of the tenth thoracic vertebra.
The cause of the abscess was not established but the acute ulcerative lesion in the mitral valve is
very likely secondary to the abcess. The severe destruction of the underlying normal valve and
fulminant course of the illness in this case makes the designation of acute bacterial endocarditis