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Luetic aneurysm

Luetic aneurysms (also called syphilitic aneurysms) are a type of aneurysm occurring usually secondary to syphilitic aortitis

Pathology

The responsible organism is a spirochete Treponema pallidum and Ascending aorta is mostly involved.

Syphilitic aortitis takes place during the stage of tertiary syphilis between 5 to 30 years after initiation of primary syphilis. This is normally due to infection of aorta secondary to endarteritis obliterans of vasa-vasorum.

Aortic wall becomes progressively weakened due to chronic inflammation. This will subsequently lead to aneurysm (10%), coronary artery narrowing at ostium (30%) and aortic valve insufficiency secondary to the involvement of aortic valve.

Radiographic features

Angiography

Findings include:

  • saccular asymmetric aortic aneurysm
  • aortic root branches involvement

We can not accurately measure aneurysm by using angiography. This is normally due to intra-aneurysmal/ mural thrombosis and calcification, layering of the contrast and magnification.,

CT

The findings of CT may include:

  • extensive thickening of aortic wall with peri-aortic inflammation
  • asymmetrical aortic sinus involvement
  • saccular aneurysms and heavily calcified ascending aorta
  • "tree bark" intimal calcifications due to intimal wrinkling

Treatment and prognosis

High-dose antibiotics and resection of enlarging aneurysm.

History and etymology

The term "Lues" is an old name for syphilis, derived from Latin lues for "filth".


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