Case 26-1979

Presentation of CaseAn 81-year-old man was admitted to the hospital because of dyspnea and weakness.He was well and active until eight years previously, when left iliofemoral thrombophlebitis developed and was treated with warfarin. Two years before admission atrial fibrillation was found, and digoxin was initiated. X-ray films of the chest (Fig. 1) showed bilateral pleural effusions, interstitial pulmonary edema and cardiac enlargement; the aorta was markedly ectatic, but without mural calcification. Warfarin was continued. One year before entry gangrene developed in the left fifth toe, and he returned to the hospital. A transfemoral angiographic examination (Fig. 2) revealed . . .