Computed Tomographic and Morphologic Features of Syphilis of the Aorta

This report describes certain computed tomographic and morphologic features of syphilitic aortitis in 2 patients in whom the process involved the entire thoracic aorta.

In 2009, a report from this institution described certain necropsy features in 90 unoperated patients seen in a 25-year period with syphilis involving the aorta. That report was the first to analyze characteristic features of vascular syphilis since 1964. During a recent 4-month period, we studied at necropsy 2 additional patients with this condition, and the findings in them were unusual enough, in our view, to prompt this report.

Description of Patients

Certain findings in each of the 2 patients are summarized in Table 1 and illustrated in Figures 1 to 3 . Patient #1 had her aneurysmal ascending aorta resected and the aortic valve replaced (bi-leaflet mechanical valve-Carbomedics) at age 68. During the next 10 years, the descending thoracic aorta progressively enlarged. Seventeen days before death, a 36-cm-long stent was placed in the descending thoracic aorta. Postoperatively, movement in the legs progressively decreased and cardiac arrest occurred. The mechanical valve in the aortic-valve position appeared to have functioned properly (This patient was on warfarin chronically.). At necropsy, nearly 2,000 ml of blood was found in the right pleural space, and a rupture site was seen at the bend in the thoracic aorta.

Table 1

Certain clinical and necropsy findings in the 2 patients with syphilis of the aorta

Variable Patient
#1 #2
Age (years) 78 71
Gender Female Male
Race Black White
Highest blood pressure (mm Hg) 180/90 145/80
Hypertension (history) + +
Aortic regurgitation + o
Obesity + +
Heart weight (g) 565 410
Operation, aorta + o
Stent, aorta + o
Cause of death Rupture, DTA Rupture, AAA
Cardiac adiposity + +

AAA = abdominal aortic aneurysm; DTA = descending thoracic aorta.

Both hearts floated in a container of formaldehyde.

Figure 1

Case #1. (A and B) Contrast-enhanced computed tomographic axial images before aortic valve replacement for aortic regurgitation 10 years before death showing a fusiform aneurysm of the ascending aorta with mural calcific deposits. The aortic sinus (black arrows) is not dilated. (C) Contrast-enhanced sagittal computed tomographic image shortly before death revealing a fusiform aneurysm of the descending aorta with atherosclerotic plaque formation. (D) Volume-rendered 3-dimensional reconstruction showing the fusiform aneurysm of the descending aorta replacement. The patient 10 years earlier had resection of the ascending aortic aneurysm, replacement of the aortic valve, and resection of the ascending aorta. A = ascending aorta, Ao = descending aorta, LV = left ventricular cavity, RV = right ventricular cavity.

Figure 2

Case #1. Views of the heart and aorta at necropsy. (A) The heart and the entire aorta. The ascending portion contains a graft. Both the arch and descending portions are diffusely dilated. Blood is present in the adventitia because of its rupture in the area of the bend. The diameter of the abdominal aorta is normal (∼1.5 cm). (B) The aorta is “de-roofed” exposing the 36-cm stent. (C) The stent has been removed exposing the interior lining. The wall of the aorta in most portions is thickened.

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Nov 28, 2016 | Posted by in CARDIOLOGY | Comments Off on Computed Tomographic and Morphologic Features of Syphilis of the Aorta

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