Death from haematemesis is recorded in a patient with a giant left atrium which had cause] dysphagia of such severity that a plastic naso-gastric fzeding tube had been introduced anJ retained for some days. (Fig. Ia, b) and she developed dysphagia, the radiographic concomitant of which was compression of the remarkably displaced, barium-filled oesophagus (Fig. 2). Dysphagia progressed, and to facilitate hydraition, which had become a problem, a nasogastric tube was passed and retained for several days. Mitral valve replacement was planned. The patient died abruptly from exsanguinating haematemesis while awaiting surgical management.At necropsy a giant left atrium was seen to compress the oesophagus; there was circumferential erosion of the oesophageal mucosa over an area 4 cm. in length, within the limits of which there was a perforation through the oesophageal wall which in turn communicated with a lateral defect in an intercostal artery which crossed to the right behind the oesophagus. The plicating sutures were easily recognized -they constituted part of a bridge across each commissure and did nothing to diminish incompetence, which was gross. It is assumed that dysphagia was from oesophageal compression from enlargement of the left atrium and that oesophageal and systemic arterial erosions were related to the presence over some days of the plastic feeding tube within the oesophageal lumen. The eroded oesophageal lumen, with clot at the site of the oesophago-arterial communication, is shown in Figure 3. 503 on 13 May 2018 by guest. Protected by copyright.