Circulation. 1999;100:1582-1583
(Circulation. 1999;100:1582-1583.)
© 1999 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Syphilitic Aortitis
Michael W. Frank, MD;
David J. Mehlman, MD;
Felix Tsai, MD;
Jon W. Lomasney, MD;
Axel W. Joob, MD
From the Divisions of Cardiothoracic Surgery, Cardiology, and Pathology,
Northwestern University Medical School, Chicago, Ill.
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Introduction
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 Top
 Introduction
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Tertiary syphilis has been virtually eliminated in
western society
in recent years. Therefore, modern images of syphilitic
aortitis
with CT scan, MRI, and transesophageal
echocardiography (TEE)
have not been available. We
present a 59-year-old man with a
history of syphilis and current
serology consistent with syphilis
(positive Venereal Disease
Research Laboratory test). He presented
with congestive heart
failure. Cardiac catheterization showed
severe aortic
insufficiency and severe ostial stenosis of both
his left main
(Figure 1
) and right
coronary arteries. Subsequent
CT scan (Figure 2
), MRI (Figure 3
), and TEE (Figure 4
) showed
prominent thickening of the
aortic wall. The patient was treated
with aortic valve replacement with
concomitant coronary artery
bypass graft surgery and
penicillin. Gross evaluation of the
ascending aorta revealed aortic
wall thickening and a coarse
granular luminal surface (Figure 5
). Histological
evaluation
of the aorta was consistent with syphilitic aortitis
(Figure
6
). The patient had a complete
and uneventful recovery.
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Figure 1. Cardiac catheterization revealing
a severe left main coronary artery ostial stenosis
(arrow).
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Figure 5. Intraoperative gross appearance of ascending
aortic lumen showing a coarse granular surface (arrow indicates
ascending aortic lumen; AVR, prosthetic aortic valve
replacement).
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Figure 6. Histological evaluation of the
aorta reveals mesoaortitis with fibrosis and destruction of the
media. In adventitial soft tissue, dense plasmolymphocytic infiltrates
are centered around vasa vasorum with endarteritis. Vascularization of
the media is also seen in B. Hematoxylin and eosin staining.
Magnification: A, x10; B, x25.
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Footnotes
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Reprint requests to Michael W. Frank, MD, Loyola University
Medical Center, 2160 S First Ave, Maywood, IL 60153.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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