Intramural hematoma and thoracic aortic aneurysm with syphilis

Asano, Masaharu; Ohtake, Hiroshi; Hanafusa, Yuji; Kazuma, Hiroshi; Tanji, Masahiro

doi:10.1016/j.jtcvs.2006.11.042

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…Intramural hematoma of the ascending aorta has also been described recently in this context. 1 The pathological hallmark is endarteritis obliterans of the vasa vasorum with a chronic inflammatory infiltrate, ischemic necrosis, and fibrosis of the medial layer. Scarring of the aortic media leads to longitudinal wrinkling of the aortic wall (tree barking); however, extension of the disease into the aortic root with coronary ostial stenosis appears to occur in a minority of cases.…”

Section: Discussionmentioning

confidence: 99%

Coronary Ostial Stenosis in a Young Patient

et al. 2012

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A 37-year-old man presented to our department complaining of severe chest pain triggered by the slightest physical exercise. The symptoms appeared 6 months previously and have gradually worsened. His medical history was unremarkable, and he had no cardiovascular risk factors except smoking. A 6-lead ECG at rest was normal, as was the chest x-ray. The ultrasonography examination revealed severe aortic regurgitation and a moderately enlarged left ventricle with normal systolic function. The treadmill test was positive for myocardial ischemia. He subsequently underwent a catheter examination that diagnosed severe right and left main coronary ostial stenoses along with severe aortic valve incompetence ( Figure 1A and 1B). A computed tomographic examination confirmed these findings ( Figure 1C and 1D), revealing an ascending aorta with a maximum transverse diameter of 3.5 cm, an irregular intima, and a thickened wall (6 mm) ( Figure 1C). He was referred for urgent replacement of the aortic valve and triple total arterial coronary bypass.At surgery, the ascending aorta had a hyperemic, inflammatory adventitia that adhered firmly to the surrounding structures. Cross-clamping revealed a markedly thickened wall, with extensive longitudinal wrinkling all the way into the aortic root, deforming and narrowing the coronary ostia (Figure 2). The aortic valve leaflets were thickened and retracted, resulting in severe, central incompetence. Aortic valve replacement with a 25-mm mechanical prosthesis and a triple total arterial coronary bypass with the use of the radial and both internal thoracic

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Section: Discussionmentioning

confidence: 99%

Coronary Ostial Stenosis in a Young Patient

et al. 2012

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“…Autopsies of patients with syphilitic aortitis have shown that findings in 9% of cases are isolated to the descending aorta 20 . Other articles have documented eccentric thickening of the aorta in addition to findings such as intramural hematoma and dissection 19,31 …”

Section: Resident Discussionmentioning

confidence: 99%

Clinical Pathologic Conference: A 65‐year‐old Male With Left‐Sided Chest Pain. A Case of an Unexpected Occupational Hazard

Egan

Pare²

2012

Academic Emergency Medicine

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The authors present a case of a 65-year-old male who presented four times to the emergency department (ED) with left-sided chest pain. On the first three visits, the patient was admitted with a different diagnosis related to his chest pain. On the final visit, an abnormality on an imaging study performed in the ED led to the ultimate diagnostic test revealing the cause of the patient's symptoms. The patient's clinical presentation and ultimate clinical course are summarized, and a discussion of the differential diagnoses of his condition is presented.ACADEMIC EMERGENCY MEDICINE 2012; 19:e1-e6 ª 2012 by the Society for Academic Emergency Medicine CASE PRESENTATIONA 65-year-old African American male presented to the emergency department (ED) with a chief complaint of chest pain. The patient complained of a 3-week history of constant sharp left-sided pain. During that time he was seen in our ED and admitted three times by different providers with the following diagnoses: cocaine chest pain, acute pancreatitis, and chest pain with electrocardiogram (ECG) changes. During each hospitalization, the patient was discharged within 24 hours with improvement and unremarkable evaluation. This is a short summary of the important findings found on chart review of his initial three visits. On Visit 1, the patient complained of chest pain and headache. Urine toxicology screening was positive for cocaine. ECG and chest radiograph were interpreted as normal. Serial troponin I and cardiac creatinine-kinase (CK) tests were obtained and were negative. On Visit 2, the patient complained of left-sided chest pain and left upper quadrant abdominal pain. The patient's serum lipase of 85 U ⁄ L (normal <63 U ⁄ L) and amylase of 157 U ⁄ L (normal <104 U ⁄ L) were slightly elevated in the setting of alcohol use. On Visit 3, the patient also complained of left upper quadrant abdominal pain in addition to the unchanged chest pain. Urinalysis was positive for microscopic hematuria. ECG showed an isolated T-wave inversion in V5 and T-wave flattening in the lateral leads. A noncontrast renal colic protocol computed tomography (CT) abdomen-pelvis scan was found to have no significant findings. Human immunodeficiency virus (HIV) testing was negative. Serial troponin I and cardiac CK tests were obtained and were negative.On Visit 4, the patient reported sharp left-sided chest pain that was constant in nature without change in quality over the last 3 weeks. He complained of severe nonradiating pain that was pleuritic in nature and dyspnea on exertion. He noted no improvement with acetaminophen, ibuprofen, oxycodone, or pantoprazole. His review of systems was negative with the exception of the symptoms noted above and an undetermined amount of unintentional weight loss. Past medical history included hypertension, gastroesophageal reflux disease, gastritis, treated scabies, Helicobacter pylori infections, and chronic back pain. The patient was not taking any medications regularly. His only allergy was penicillin, which caused adverse gastrointes...

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“…[1,4] Neurosyphilis was common befor the penicillin era, but now it is uncommon as effective treatment is available. [1] Several case reports have described association between syphilis and aneurysms, [5] infarction, [6] or both conditions. [7] In Taiwanese patients, atherosclerosis is the common cause of carotid occlusion, of the forty-four patients studied, only one patients had arterial occlusion due to syphilis.…”

Section: Discussionmentioning

confidence: 99%

Left subclavian artery aneurysm secondary to syphilitic arteritis presenting with a right ischemic cerebellar infarction

Lin¹

2009

Neurol India

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We report a 28-year-old male who presented with severe vertigo, vomiting, diplopia, clumsiness of right extremities. Physical examination revealed low reading of blood pressure in the left upper limb and evidence of mild left upper limb ischemia. On neurological examination he had right cerebellar ataxia. Computed tomography and magnetic resonance imaging, revealed an acute right cerebellar infarction in the anterior inferior cerebellar artery territory. Doppler ultrasono-graphy revealed an aneurysm of the left subclavian artery. The patient was tested positive for serology of syphilis.

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Intramural hematoma and thoracic aortic aneurysm with syphilis

Cited by 6 publications

References 4 publications

Coronary Ostial Stenosis in a Young Patient

Coronary Ostial Stenosis in a Young Patient

Clinical Pathologic Conference: A 65‐year‐old Male With Left‐Sided Chest Pain. A Case of an Unexpected Occupational Hazard

Left subclavian artery aneurysm secondary to syphilitic arteritis presenting with a right ischemic cerebellar infarction

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