Luetic aneurysms (also known as 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.
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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.
The 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 periaortic 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" is an old name for syphilis, derived from Latin lues for "filth".