21st-Century Imaging for a 19th-Century Disease
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.
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.
- Copyright © 1999 by American Heart Association