Miscellaneous
Syphilis as a Cause of Thoracic Aortic Aneurysm

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In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm.

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Methods

Since March 1993, all operatively excised specimens excised by cardiovascular surgeons at the BUMC have been described grossly and histologically by WCR and photographed mainly by JMK, and since 2003, the clinical records were available online. From January 1, 2009, to December 31, 2014, 23 patients were found to have diffuse panaortitis of the tubular portion of ascending aorta. The diffuseness of the involvement of the ascending aorta was determined by gross examination and the panaortitis by

Results

Pertinent findings in each of the 23 patients are listed in Table 1. The 11 men ranged in age from 33 to 84 years (mean 61), and the 12 women from 58 to 83 years (mean 70). Eighteen were white; 4, black; and 1, Asian. The body mass index ranged from 16 to 47 kg/m2 (mean 28); it was >25 in 15 (65%).

The aneurysm involved the ascending portion of aorta in all 23 patients, the arch portion in 12, and the descending thoracic portion in 10. In all patients, the aneurysm was fusiform, that is, the

Comments

The major purpose of this report is to emphasize that syphilis remains a major cause of aneurysm of the ascending aorta with or without similar involvement of the arch and descending thoracic aorta. The 23 cases described here were seen in just over a 6-year period such that nearly 4 cases of syphilitic aortic aneurysms were resected at BUMC yearly.

Several decades ago, an STS was a requirement for admission to any US hospital. Today, an STS is infrequently performed in hospitalized patients in

Disclosures

The authors have no conflicts of interest to disclose.

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The study was funded by the Baylor Health Care System Foundation, 3600 Gaston Avenue, Barnett Tower, Suite 100 Dallas, TX 75246.

See page 1303 for disclosure information.

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