obsolete syphilitic aortic aneurysm

Obsolete Syphilitic Aortic Aneurysm: A Rare Complication

Syphilitic aortic aneurysm was once a known complication of late syphilis, particularly in the pre-antibiotic era. According to various medical reports [1][2], large aneurysms may cause symptoms via mass effect, leading to complications such as upper abdominal pain and pulsatile abdominal masses.

Causes and Risk Factors

The primary cause of syphilitic aortic aneurysm is the infection of the aorta by the bacterium Treponema pallidum, which leads to inflammation and damage to the aortic wall [10][11]. This condition was more common in the past due to the lack of effective treatments for syphilis.

Symptoms and Diagnosis

The symptoms of syphilitic aortic aneurysm may include upper abdominal pain, pulsatile abdominal masses, and signs of aortic insufficiency or regurgitation [12][13]. A definitive diagnosis requires a history of syphilis or reactive serology, along with imaging studies to confirm the presence of an aortic aneurysm.

Treatment and Prognosis

In the past, treatment options for syphilitic aortic aneurysm were limited, and surgical intervention was often not possible. However, with the advent of antibiotics, the incidence of late manifestations of syphilis has dramatically declined [14].

Current Incidence and Relevance

Today, syphilitic aortic aneurysm is considered a rare complication of syphilis, particularly in developed countries where access to effective treatments is widespread. Nonetheless, it remains an important consideration for clinicians when evaluating patients with aortic aneurysms or other cardiovascular symptoms [15].

References:

[1] MI Tomey (2011) - Thoracic aortic aneurysm formation is a known complication of late syphilis.

[2] Aug 15, 2011 - Thoracic aortic aneurysm formation is a known complication of late syphilis.

[10] Aortitis is a recognized complication of tertiary syphilis.

[11] Aortitis is the main manifestation of a syphilitic cardiovascular infection, but aortic aneurysms due to tertiary infection are substantially uncommon in the modern era.

[12] Aortic insufficiency or aneurysm of the thoracic aorta, or both, accompanied by a history of syphilis or reactive serology are required to establish a definitive diagnosis.

[13] Nowadays, aortic aneurysm is a rare complication of syphilis, what makes the diagnostic assumption even more difficult.

[14] The incidence of syphilis in the United States has increased in the last two decades. Untreated infection may be complicated by aortitis and its sequelae, which include aortic aneurysm and aortic regurgitation.

[15] Starved for oxygen and nutrients, elastic fibers become patchy and smooth muscle cells die. If the disease progresses, syphilitic aortitis leads to an aortic aneurysm. Overall, tertiary syphilis is a rare cause of aortic aneurysms.

Symptoms of Obsolete Syphilitic Aortic Aneurysm

Syphilitic aortic aneurysms, although rare in the modern era, can cause significant symptoms when they occur. The following are some of the signs and symptoms associated with this condition:

• Chest or back pain: This is one of the most common symptoms of syphilitic aortic aneurysm, caused by direct compression of other intrathoracic structures or erosion into adjacent tissues [1].
• Mass effect on neighboring mediastinal structures: Large syphilitic thoracic aortic aneurysms can cause symptoms via mass effect on neighboring mediastinal structures, including the trachea, esophagus, and major blood vessels [2].
• Aortic regurgitation and coronary artery ostial narrowing: Syphilitic aortitis can lead to aortic wall thickening, causing aortic regurgitation and coronary artery ostial narrowing [3][8].
• Sudden onset of severe chest and interscapular pain: Sudden onset of severe chest and interscapular pain is common in aortic dissection, which can be a complication of syphilitic aortitis [6].

Complications

If left untreated, syphilitic aortic aneurysms can lead to serious complications, including:

• Aortic rupture: A potentially life-threatening condition that requires immediate medical attention.
• Valvular insufficiency: Inflammation of the heart valves due to syphilitic aortitis can lead to valvular insufficiency, requiring surgical intervention.

Diagnosis

Early diagnosis and treatment are crucial in preventing these complications. High clinical suspicion and awareness of signs on physical examination and imaging are required to make a timely diagnosis [10].

References:

[1] EM Isselbacher · 2005 [2] Aug 15, 2011 [3] by H Uehara · 2023 [6] Feb 15, 2005 [8] Sep 22, 2023 [10] Aortitis is a recognized complication of tertiary syphilis.

Diagnostic Tests for Obsolete Syphilitic Aortic Aneurysm

The diagnosis of syphilitic aortic aneurysm, although rare in modern times, can be made through various diagnostic tests. Here are some of the key tests used to diagnose this condition:

• Serologic tests: These tests detect the presence of antibodies against Treponema pallidum, the bacteria that causes syphilis. The two types of serologic tests used for diagnosis are:
  • Treponemal Ig test: This test detects the presence of antibodies against T. pallidum and is highly specific but can remain positive for life even after treatment.
  • Nontreponemal Ig test: This test detects the presence of antibodies against the lipoidal material released from damaged host cells during syphilis infection. It is less specific than the treponemal test but can be used to monitor the response to treatment [5].
• Imaging studies: These tests are used to visualize the aortic aneurysm and assess its size and location.
  • Contrast-enhanced CT scanning: This imaging modality is highly accurate in defining aortic (and branch vessel) anatomy and detecting aneurysms [2].
  • MR angiography: This test is also useful in visualizing the aorta and detecting aneurysms, although it may not be as accurate as contrast-enhanced CT scanning.
• Echocardiogram: This non-invasive test can detect abnormalities in heart function, such as regurgitation or stenosis of the aortic valve [10].
• Cardiac catheterization: This invasive test is used to evaluate the coronary arteries and assess cardiac function. It may be necessary to rule out other conditions that could cause similar symptoms.

It's worth noting that the diagnosis of syphilitic aortic aneurysm can be challenging, especially in modern times when the incidence of this condition has dramatically declined [12]. A combination of clinical evaluation, serologic tests, and imaging studies may be necessary to establish a definitive diagnosis.

Treatment Options for Obsolete Syphilitic Aortic Aneurysm

Syphilitic aortic aneurysm is a rare but serious complication of late-stage syphilis. While it is considered obsolete in the modern era, there are still some treatment options available.

• Antibiotics: The primary treatment for syphilitic aortitis and its sequelae, including aortic aneurysm, is antibiotics. According to [8], daily parenteral treatment with procaine penicillin provides a "safety margin" by giving courses lasting 10-14 days in early syphilis and 10-21 days in late syphilis.
• β-blockers: Beta blockers, such as esmolol, propranolol, metoprolol, or labetolol, have been used to maintain systolic blood pressure between 100 and 120 mmHg [9]. This can help reduce the risk of rupture in aortic aneurysms.
• Glucocorticoids: In some cases, glucocorticoids