Gross Description

The body was that of an elderly white male weighing 54 kg. and measuring 167 cm. The heart weighed 400 g, with hypertrophy of the left ventricle. Marked dilatation of the aortic arch was evident. A 10 cm segment of the thoracic aorta below the arch was replaced by prosthesis. Suture lines were intact. The abdominal aorta and iliac vessels showed a moderate degree of atherosclerosis with some calcification. The intimal surface of the aortic root and arch showed changes consistent with a "tree bark" appearance with pearly-grey plaques and sclerosis (Figure 74). The lungs were edematous with centrilobular emphysema. The distal esophagus was adherent to both pleural surfaces and to a massive blood clot associated with fibrous tissue. On opening, a large defect was noted in the esophageal wall approximately 10 cm from the gastric cardia. The defect was consistent with an oval ulcer measuring 3 cm in its greatest dimension that extended through the full thickness of the wall (Figure 75). The edges were sharp, not raised and clearly demarcated. A major portion of the stomach was absent and there was evidence of a Billroth type II anastomosis. The remaining organs showed no significant pathology.

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