Viewed from behind one can see the mid portion of the oesophagus just below the level of the
bifurcation of the trachea. There is a 2cm oesophageal ulcer in the base of which there is clotted
blood. In front of the oesophageal ulcer there is a fusiform aneurysm of the descending aorta
containing laminated clot and it is this which has ruptured into the oesophagus. In the arch of the
aorta there is some atheroma together with a faint vertical "tree-bark" wrinkling which is
characteristic of syphilitic aortitis.
This man was admitted to hospital in 1953 at the age of 76 with haematemesis and
melaena. At autopsy, fusion of the posterior aortic cusps was demonstrated. The aneurysm
described, in addition to involving the oesophagus, was also firmly adherent to the 6th thoracic
vertebra. Microscopy of the aorta confirmed this was syphilitic aortitis.