Aneurysm and dissection in a patient with syphilitic aortitis

Júnior, Fernando Pivatto; Finkler, Bruno Schaaf; Torres, Felipe Soares; Schaefer, Pedro Guilherme; Sprinz, Eduardo

doi:10.1016/j.bjid.2017.01.003

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…In addition, there are symptoms of heart failure, and it is usual for a murmur to be auscultated at the right sternal border 16 ; in our patient, a Grade III systolic murmur was audible in all foci, with high predominance in the aortic focus. The second most common complication is syphilitic aneurysm, which is 3 times less frequent than aortic regurgitation and is detected in 5-10% of patients; Grade II aortic regurgitation, moderate grade aortic valve calcification, and aneurysm of the aortic root and ascending aorta were found in our patient, which is consistent with the literature on the most common location of aneurysms (50% in the ascending aorta, 35% in the aortic arch and 15% in the descending aorta) [17][18][19][20] .…”

Section: Discussionsupporting

confidence: 90%

Syphilitic aortitis: About a case in South Colombia

Peña¹,

Franco²,

Gonzales-Cerón³

et al. 2021

ACME

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The case of a 73-year-old female patient obtained and resident of Florencia, Caquetá (Colombia), with a history of hypertension who is admitted to a highly complex hospital due to a 3-month clinical picture of constant evolution in pain is presented. Thoracic oppressive type pain in the anterior region of the left thorax, non-irradiated, of intensity 8/10. The echocardiogram shows calcified aortic valve disease with severe aortic stenosis, aortic regurgitation, left ventricular hypertrophy, and mild grade mitral regurgitation. Within the pre-surgical studies, she presented VDRL with 1:4 dilutions and the diagnosis was confirmed with the result of the treponemal test and other infectious diseases were ruled out. Valvular replacement was performed with a bioprosthesis plus a supra-coronary valvular tube. In the biopsy, chronic scar valvulitis with extensive calcifications was confirmed. After the surgical intervention, discharge was performed due to adequate clinical evolution.

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Section: Discussionsupporting

confidence: 90%

Syphilitic aortitis: About a case in South Colombia

Peña¹,

Franco²,

Gonzales-Cerón³

et al. 2021

ACME

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“…In the past decade, several cases of syphilitic thoracic aortic aneurysm have been reported with variable clinical presentation such as simultaneous involvement of the brain, spinal cord (neurosyphilis), lungs (pulmonary syphilis), and rupture or dissection of thoracic aortic aneurysm (cardiovascular syphilis) [5,7,[16][17][18][19][20]. Our case is a classic presentation of isolated cardiovascular syphilis presented with a large thoracic aortic aneurysm confirmed with TP-PA testing and radiological imaging.…”

Section: Discussionmentioning

confidence: 63%

Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics

Chaudhary

Faghihimehr

Subedi

et al. 2021

Cureus

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A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest. Further workup demonstrated a positive syphilis test. Untreated earlier stages of syphilis attribute to the development of the ascending aortic aneurysm. The patient was medically treated with IV penicillin and underwent surgical repair of the aortic aneurysm. Histopathology confirmed the diagnosis of syphilitic aortitis. Tertiary syphilis often presents several years after initial infection and usually after a latent phase, making it difficult to diagnose. Syphilitic aortic aneurysms may result in a high mortality rate in untreated patients. Therefore, a high index of suspicion is required for the early recognition of a syphilitic aortic aneurysm. Early treatment with antibiotic therapy and surgical repair of syphilitic aortic aneurysms can prevent life-threatening complications.

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“…Since ascending and thoracic aorta are rich in lymphatics, spirochetes have tropism for these aortic segments. [10][11][12][13] The tendency of spirochetes to dwell in the small vessels of the vasa vasorum leads to an adventitial chronic inflammation, mainly in the arterioles that perfuse the media layer. 6 The immune system response involves infiltration of plasmacytes and lymphocytes into the aortic wall layers, creating a diffuse and fibrous thickening of the intima.…”

Section: Discussionmentioning

confidence: 99%

“…7 In fact, the vasa vasorum undergoes a process of endarteritis obliterans and necrosis of the media, and the elastic tissue of the vessel is destroyed and replaced by scar tissue. 11,12 This inflammatory process can continue for a long time after the initial infection, which can explain the cardiovascular manifestations of syphilis aortitis generally occurring 10 to 30 years after the original untreated infection. 2,7,14 Indeed, Heggtveit 15 reported that among patients with syphilitic aortitis, 50% of the aortic aneurysms developed in the ascending aorta and 35% in the aortic arch, followed by 15% in the descending aorta.…”

Section: Discussionmentioning

confidence: 99%

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

Bilman¹,

Bertoglio²,

Melissano³

et al. 2021

J. vasc. bras.

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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.

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Aneurysm and dissection in a patient with syphilitic aortitis

Cited by 9 publications

References 11 publications

Syphilitic aortitis: About a case in South Colombia

Syphilitic aortitis: About a case in South Colombia

Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics

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

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