A rare and forgotten cause of aortic aneurysm: tertiary syphilis

Cardiovascular syphilis occurs 15 to 30 years after infection. Syphilitic aortitis is the most common manifestation and typically involves the ascending aorta. Aneurysm formation is the least common complication of aortitis; the majority of aneurysms are single and usually saccular. We report the images of a 51-year-old man with a history of chest pain that began one month before. An aneurysm of the ascending aorta was documented. The nontreponemal and treponemal tests were reactive. Other venereal diseases, as well as neurological involvement, were discarded. The patient received treatment for non-neurologic tertiary syphilis and surgical repair by the Bentall procedure with re-implantation of the coronary arteries. Pathology showed the aortic arterial layer displaying myxoid changes in the tunica intima, as well as inflammatory infiltrate. The vasa vasorum demonstrates inflammatory infiltration with lymphocytes and plasma cells. The previous findings support the diagnosis of syphilitic aortitis. The patient’s evolution was satisfactory with no current cardiovascular symptoms.

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report

Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.