Images in Clinical Medicine
Syphilitic Aortitis
N Engl J Med 2002; 346:676February 28, 2002
- Article
Figure 1 Examination of a 74-year-old man with a one-year history of mild, stable angina revealed a murmur consistent with the presence of aortic regurgitation. Echocardiography demonstrated severe aortic regurgitation as a result of marked dilatation of the aortic root (diameter, 5.4 cm in the proximal ascending aorta). Gadolinium-enhanced magnetic resonance angiography (Panel A) revealed saccular dilatation of the aorta from its root to beyond the distal arch (short arrows), with involvement of the innominate artery (long arrow). T1-weighted images also revealed evidence of mural thrombus in the superior aspect of the aneurysm, beyond the left subclavian artery (arrow in Panel B). Serologic immunofluorescence studies revealed the presence of Treponema pallidum antigen, confirming the clinical suspicion of syphilitic aortitis and aneurysm. The patient received 10 days of intramuscular penicillin G procaine with oral probenecid without complications, and he continues to receive medical therapy under close surveillance.
The cardiovascular complications of syphilis predominantly involve the aorta, leading to the formation of aneurysms and aortic-valve incompetence. Angina may result from coronary ostial stenosis or associated atherosclerosis. The incidence of tertiary syphilis has declined in recent decades owing to the early recognition of the disease and the sensitivity of the pathogen to antibiotics. However, the reemergence of syphilis in the developing world, particularly among drug abusers and the sexually promiscuous, may mean that the delayed cardiovascular and neurologic complications of late syphilis will be seen with increasing frequency.
Peter J. Pugh, M.B., B.S.
Ever D. Grech, M.D.
Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom- Citing Articles (3)
Citing Articles
1
Daniel J. Egan, Joseph R. Pare. (2012) Clinical Pathologic Conference: A 65-year-old Male With Left-Sided Chest Pain. A Case of an Unexpected Occupational Hazard. Academic Emergency Medicine 19:2, e1-e6
CrossRef2
Fabio Tavora, Allen Burke. (2006) Review of isolated ascending aortitis: differential diagnosis, including syphilitic, Takayasuʼs and giant cell aortitis. Pathology 38:4, 302-308
CrossRef3
M. Revest, O. Decaux, T. Frouget, C. Cazalets, B. Cador, P. Jégo, B. Grosbois. (2006) Les aortites syphilitiques. Expérience d'un service de médecine interne. La Revue de Médecine Interne 27:1, 16-20
CrossRef
