A 27-Year-Old Man Comes to the Emergency Department Due to Acute-Onset

A 27-year-old man comes to the emergency department due to acute-onset chest pain and shortness of breath.  The pain started suddenly an hour ago while he was lifting a box of books.  The patient has no chronic medical conditions, and he was in his usual state of health prior to the onset of symptoms.  He does not use tobacco, alcohol, or illicit drugs.  Height is 182 cm (71.7 in) and weight is 72 kg (158.7 lb) .  On physical examination, the patient is in acute respiratory distress.  Temperature is 37 C (98.6 F) , blood pressure is 90/60 mm Hg, pulse is 120/min and regular, and respirations are 26/min.  Pulse oximetry shows 86% saturation on room air.  Cardiopulmonary examination reveals pectus excavatum, bilateral pulmonary crackles, and a decrescendo diastolic murmur at the right upper sternal border.  The abdomen is soft and nontender.  There is no peripheral edema.  Subsequently, the patient develops cardiac arrest and dies.  Which of the following histologic changes is most likely to be seen on autopsy?

A) Atherosclerotic thickening of the intima
B) Coagulative necrosis of the left ventricular wall
C) Fragmentation of the elastic lamellae in the aortic media
D) Necrosis of the papillary muscles
E) Perivascular inflammation around the vasa vasorum

Correct Answer:

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