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(Circulation. 1999;100:884-885.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

21st-Century Imaging for a 19th-Century Disease

Didier de Cannière, MD, PhD; Thierry Simonart, MD; Jean-Luc Jansens, MD; Dominique Parent, MD, PhD

From the Departments of Cardiac Surgery (D.d.C., J.-L.J.) and Dermatology (T.S., D.P.), Erasmus University Hospital, Brussels, Belgium.

Correspondence to Dr Didier de Cannière, Department of Cardiac Surgery, Erasmus University Hospital, Brussels 1070, Belgium. E-mail dolc@skynet.be

	Introduction

 
Syphilis has become an extremely unusual cause of ascending aortic aneurysms, with barely 41 reported cases since the era of penicillin. The surgical strategy depends on 2 determinants: the need to replace the aortic valve, if it is involved, and the existence of a collar of normal aortic tissue upstream to the brachiocephalic trunk, enabling the surgeon to clamp the aorta and insert the prosthesis graft without circulatory arrest and reimplantation of the cephalic trunks. Imaging is thus of paramount importance to decide prospectively between 4 very different procedures: a Bentall operation, an arch repair in circulatory arrest, a combination of the 2, or a simple ascending aortic replacement. We report the case of a 54-year-old white man in whom a routine chest radiograph revealed an aortic aneurysm that proved to be of syphilitic origin (VDRL+ at 1:4; FTA+ at 1:400; TPHA+ at 1:400; HIV-). In this case, only a tridimensional CT scan reconstruction of the ascending aorta (and neither angiography [Figure 1] nor NMR [Figure 2]) enabled us to answer the above-mentioned questions by showing the landmarks with the adjacent structures. A successful operation in circulatory arrest followed by a 2-week course of intravenous penicillin led to complete recovery.

View larger version (144K): [in this window] [in a new window]   Figure 1. Angio NMR showing aneurysm compressing pulmonary artery but not precise landmarks of aortic valve, brachiocephalic trunk, or carotid artery.

View larger version (154K): [in this window] [in a new window]   Figure 2. Tridimensional reconstructions of thoracic aorta and adjacent structures. Involvement of brachiocephalic trunk in aneurysmal bag is clearly highlighted. A, Left profile. B, Left profile+30° rotation. . . . [Full Text of this Article]