Coarctation of The Aorta

Clinical History

This 11 year old male was admitted with a history of high fever over a period of 7 days, 3 weeks previously. There was night sweating and this was followed by lassitude with aching pains in the abdomen. Examination revealed a pyrexic, pale child, pulse 90, respiratory rate 20, BP 150/100 mm Hg in the right arm. There was no cardiomegaly. A systolic murmur and thrill were present at the base of the heart and transmitted into the neck. Femoral pulses were weak and delayed. The BP over the right leg was 90/50 mm Hg. There was mild clubbing of the fingers and splinter haemorrhages. The spleen was palpable. It was considered that this boy had had a coarctation of the aorta with subacute bacterial endocarditis. Blood cultures were negative but ESR was 58 mm/hr, and there was microhaematuria. Following a course of antibiotics an operation was performed with satisfactory post-operative recovery. The operation specimen is displayed.

Pathology

The specimen is a piece of aorta with a narrowed proximal end (coarctation) and 3cm of distal vessel. There is a small opening 2mm in width in the aortic wall associated with an atheromatous patch. This leads into an aneurism 2 x 1_cm in which there is some antemortem thrombus. External surface of the aneurism is haemorrhagic.