Luetic aneurysm

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

For a general discussion, and for links to other system specific manifestations, please refer to the article on syphilis. 

Pathology

The responsible organism is a spirochete Treponema pallidum and the ascending aorta is most commonly 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 the aorta secondary to endarteritis obliterans of the vasa-vasorum vasorum.

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

Radiographic features

CT

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

Angiography - DSA

Findings include

• saccular asymmetric aortic aneurysm
• aortic root branches involvement

The aneurysm diameter is often not accurately measured by using angiography. This is normally due to intra-aneurysmal / mural thrombosis and calcification, layering of the contrast and magnification.

Treatment and prognosis

High-dose antibiotics and resection of enlarging aneurysm.

History and etymology

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