4. Epidemiology
Clinical Features
Investigations
Treatment
Prognosis
Follow up
• Early 20th century: 5-10% of death due to cardiovascular disease
• Treatment with penicillin since 1940: sharp decline in incidence
and mortality
• Rarity in recent times: published as case reports
• Re-emergence of syphilis in south east Asia and sub-saharan
Africa: delayed complications may arise
• Still a major cause of ascending aortic aneurysm
9. Epidemiology
Clinical Features
Investigations
Treatment
Prognosis
Follow up
Syphilis of the great vessels
• Aorta, Pulmonary arteries, great vessels arising from
aorta
• Syphilis of aorta: most common
• Blood borne disssemination in early stage- treponemes
reach vasa vasorum-endarteritis obliterans
• Aorta is rich in lymphatics: favoured
12. Epidemiology
Clinical Features
Investigations
Treatment
Prognosis
Follow up
Syphilis of the great vessels
Ascending aorta: aneurysm of signs
• M/C site of aneurysm due to syphilis
• Parasternal dullness on percussion
• Arterial pulsation on 2nd and 3rd right spaces
• Loud aortic systolic murmur, systolic thrill and loud S2
• Pessure effect: chest pain/ SVC compression
• Rupture: sudden death
13. Epidemiology
Clinical Features
Investigations
Treatment
Prognosis
Follow up
Syphilis of the great vessels
Arch of aorta: aneurysm of
symptoms
• Pulsating mass in
suprasternal notch
• May press on trachea:
stridor/brassy cough
• Left RLN: hoarseness
• Tracheal tug
• Cervical sympathetic
chain: Horner syndrome
• SVC compression
• Subclavian steal
syndrome
• Erosion of T4-T5
• Pressure on nerve
roots
• Death: rupture into
any of mediastinal
structures
50-year-old man presented with a 1-month history of backache. The clinical examination was remarkable for tenderness in the thoracic spine, early diastolic murmur in the aortic area, and loud aortic component of second heart sound. Chest radiography showed mediastinal widening (arrows) suggestive of an aneurysm of the descending thoracic aorta (A). Two-dimensional transthoracic echocardiography (B, Online Video 1) and aortic root angiography (C, Online Video 2) revealed moderate aortic regurgitation with a dilated ascending aorta. Coronary angiography showed critical stenosis (arrow) of the ostial left main coronary artery (D, Online Video 3). Computed tomography confirmed an aneurysm of the descending thoracic aorta, which was filled with thrombus and eroding D3 to D7 vertebral bodies (E and F). These features were suggestive of syphilitic cardiovascular disease and confirmed with diagnostic titers ona Treponema pallidum hemagglutination assay. The patient was treated with benzathine penicillin and referred for early aneurysm repair, Bentall procedure, and coronary artery bypass surgery, followed by spine stabilization.
50-year-old man presented with a 1-month history of backache. The clinical examination was remarkable for tenderness in the thoracic spine, early diastolic murmur in the aortic area, and loud aortic component of second heart sound. Chest radiography showed mediastinal widening (arrows) suggestive of an aneurysm of the descending thoracic aorta (A). Two-dimensional transthoracic echocardiography (B, Online Video 1) and aortic root angiography (C, Online Video 2) revealed moderate aortic regurgitation with a dilated ascending aorta. Coronary angiography showed critical stenosis (arrow) of the ostial left main coronary artery (D, Online Video 3). Computed tomography confirmed an aneurysm of the descending thoracic aorta, which was filled with thrombus and eroding D3 to D7 vertebral bodies (E and F). These features were suggestive of syphilitic cardiovascular disease and confirmed with diagnostic titers ona Treponema pallidum hemagglutination assay. The patient was treated with benzathine penicillin and referred for early aneurysm repair, Bentall procedure, and coronary artery bypass surgery, followed by spine stabilization.