SONOWORLD : Syphilitic aortitis

Username

Password

181,666 Registered Members as of 07/09/2020.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Vascular » Aortoiliac

Syphilitic aortitis

« Back to Listing

Author(s) :

Saito Oc

Funari Wiedman

Presentation A 47 year old asymptomatic Caucasian male presents with complaints of a slow growing pulsatile mass at the right upper chest

Caption: Transverse view of the ascending aorta

Description: This view also demonstrates the enlarged ascending aorta in the transverse plane.

Caption: Spectral waveform analysis of ascending aorta

Description: The spectral waveform demonstrates a pattern consistent with a turbulent blood flow in the aorta.

Caption: Sagittal view of the ascending aorta

Description: The ascending aorta shows a saccular enlargement.

Caption: Sagittal color Doppler view of the ascending aorta

Description: Marked turbulence of flow is noted in the ascending aorta.

Caption: Non-contrast enhanced CT image

Description: The ascending aorta shows saccular aneursymal enlargement, reaching up to the anterior chest wall, eroding the overlying ribs and causing a protruding mass. A faint rim of calcification is seen in the enlarged aorta.

Caption: Contrast enhanced CT scan

Description: The aneurysmally enlarged aorta shows evidence of mural thrombosis.

Differential Diagnosis Syphilitic aortitis, atherosclerotic aneurysm, mycotic aneurysm, cystic medial necrosis

Final Diagnosis Syphilitic aortitis causing aneursymal dilatation of the ascending aorta

Discussion Syphilis [previously known as “lues“] is a sexually transmitted bacterial disease caused by a spirochete Treponema pallidum. Syphilitic infection can cause many complications, of which cardiovascular- and neuro-syphilis that occur in tertiary syphilis can be fatal.

Syphilitic infection causes vasculitis involving the vasa vasorum, destruction of the collagen and elastin components of the aortic wall resulting in a saccular or fusiform (spindle-shaped) aneurysm. The other cardiovascular lesions of syphilis include aortic aortitis, aneurysm of sinus of Valsalva and aortic regurgitation.

Syphilitic aneurysm may be suspected when a linear calcification of the ascending aorta is detected on the thoracic radiograph. Atherosclerotic disease seldom produces such radiological findings and more commonly involves the abdominal aorta or the descending thoracic aorta. Ultrasound and CT scan is usually diagnostic and management involves surgery.

Case References 1. Mickley V, Mohr W, Orend KH, Sunder-Plassmann L. Aneurysm of the descending thoracic aorta in tertiary syphilis. Vasa. 1995; 24(1):72-6.
2. K. Schürmann, K. Chalabi, J. Tacke, RW Günther, D. Vorwerk. Luetic aneurysm of the descending thoracic aorta: mid-term results of endovascular treatment. http://www.eurorad.org/case.cfm?uid=1224.

Follow Up Cerebrospinal fluid analysis was positive for syphilis. The patient underwent surgical correction of the aneurysm by hemashield Teflon graft and the histopathological analysis of a fragment of the aorta revealed syphilitic aortitis, producing the classical tree-barking pattern.

Other Cases in This Category

Vascular >> Aortoiliac

Abdominal aortic dissection
Patient is a 53 year old man who arrived in the Emergency Room complaining of epigastric pain. He stated the pain at times radiated to his back and he felt pressure in his chest. He had no other ...

Aortic aneurysm with intraluminal thrombus
A 60 year old man presented with vague pain in the abdomen of four months duration. A bruit was heard over the aorta, in the infraumbilical region. All peripheral pulses were well felt.

Spontaneous aortic dissection
A 67year-old woman presented with excruciating, non-radiating pain in the peri-umbilical region. She also complained of back pain which started at about the same time as the abdominal pain. An ...

Mural thrombus in the aorta
A 95 year old male presented with right calf pain and shortness of breath. He was diagnosed with pulmonary embolism and acute right deep vein thrombosis. His past medical history is significant ...

Ruptured abdominal aortic aneurysm
A 62-year-old man presented with spontaneous pneumothorax, lumbar pain and pain in the lower limbs. Biochemical investigations revealed a low hemoglobin and hematocrit. Plain abdominal ...

Abdominal Aorta Aneurysm
61 year old asymptomatic male patient. Smoker of 2 packages of cigarettes/day for many years. A screening abdominal sonogram was performed.

Dissection of the aorta and the left iliac artery
62 year old male patient who was examined by a cardiologist a few days earlier because of sudden severe chest pain. The cardiologist could not find an abnormality. The pain is now mainly located ...

Dissection of abdominal aortic aneurysm
This is the scan of the abdominal aorta in a 40-year-old man with this established diagnosis.