Dissecting aneurysm of the aorta secondary to tuberculous aortitis.

G. P., aI 55-year-old man was admitted to the hospital onI March 28, 1953, with abdominal pain of 1 week's (luration, cough, and dyspnea. The pain radiated to the chest, back, and interscapular region. There was a history of genitourinary and skeletal tuberculosis dating back to 1919, and the left epididymis and left kidney had been removed. Hypertension had been present for 6 or 7 years. Since April 1952 he had been treated for recurrent tachycardia and syncope. The past history was otherwise not significant, and the family history was negative. On physical examination, the blood pressure was 230/130, the heart was enlarged, and there were signs of mild congestive heart failure. Grade III hypertensive retinopathy and optic atrophy of the right eye were present. There was a normal hemogram, the blood urea nitrogen was normal, and the serologic test for syphilis was negative. An electrocardiogram showed left ventricular hypertrophy and digitalis effect. Roentgenologic examination of the chest revealed cardiac enlargement, chiefly left ventricular. a tortuous elongated aorta, and old healed calcific tuberculosis in both upper lobes (fig. 1). An intravenous urogram (lisclosed a normal right pelvocalyceal system and ureter; the left was not visualized. X-rays of the spine revealed evidence of both healed and active tuberculosis involving the first 4 lumbar vertebrae. Several (lays after admission hoarseness developed, and prominence of the left hilum was seen in the chest films (fig. 1A). Planigraphic examina-