Inside the arch of the aorta just beyond the origin of the left subclavian artery there are two tears in
the intima; these are associated with dissection of the adventitia.
These wounds were produced by a Ramset nail some 8.0 cm long which ricocheted and
penetrated the chest wall transfixing the left upper lobe of the lung and penetrating the arch as seen
here. The dissection in the adventitia extended into the pericardium proximally and to the level of
the diaphragm distally. Death was from blood loss into the pleural cavity.