AORTA - Ruptured syphilitic aneurysm

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.