SONOWORLD : Syphilitic aortitis

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Vascular » Aortoiliac

Syphilitic aortitis

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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.

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