This specimen consists of the mediastinal structures, including trachea, aortic arch and part of each
pulmonary artery. The mediastinal lymph nodes are markedly enlarged but remain discrete.
The patient was a 51-year-old woman with a history of asthma who apparently died
suddenly without medical attention. At autopsy, the left chest was obliterated by old adhesions and
the apex of the right lower lobe was adherent to the chest wall. Microscopy of the lung and
mediastinal lymph nodes showed non-caseating granulomas consistent with sarcoidosis. Her heart
was enlarged weighing 740 grams, and microscopy of the heart showed myocardial lesions
suggestive of acute rheumatic carditis rather than sarcoidosis. The liver and spleen showed changes
of venous congestion. Death was ascribed to rheumatic heart disease and the finding of sarcoidosis
was regarded as incidental.