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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