The specimen is a heart opened to display the right atrium and both ventricles. The ventricles are
normal. Scattered small pale brown vegetations are seen on the leaflets of the mitral, tricuspid and
pulmonary valves. The features are those of a resolving bacterial endocarditis.
This young man was severely injured in a motorcycle accident, suffering a liver laceration
and ruptured spleen. He underwent suturing of the liver laceration and splenectomy, but later
developed septicaemia. Despite aggressive treatment he died 11 days after the accident.
Microscopic examination of the left ventricle showed microfoci of infarction. There was early
diffuse alveolar damage in the lungs and the kidneys showed resolving acute tubular necrosis.
These features are indicative of the shock syndrome and are probably due to profound