Syphilitic aneurysms

Case contributed by Senai Goitom Sereke
Diagnosis almost certain


Vague abdominal pain for about two months. Recent diagnosis of HIV and treponema pallidum infections.

Patient Data

Age: 35 years
Gender: Male

Multifocal thoracic and abdominal aortic aneurysms (both saccular and fusiform but predominantly saccular) with multiple pseudo-aneurysms and associated multilevel varying sizes mural thrombus extending from the level of the aortic arch and its branches to the right common iliac artery. Associated extensive aortic wall calcifications. The celiac, SMA, and IMA arise from aneurysms. The aortic root, ascending aorta, and origins of the renal arteries are spared.

Multifocal abdominal aortic aneurysmal mural thrombus exerts a mass effect on the surrounding solid organs (i.e. displacing the pancreas anteriorly). Complete occlusion of a long segment of the left external iliac artery.

Case Discussion

Syphilitic aneurysms, aka luetic aneurysms, are due to syphilitic aortitis and are manifestations of tertiary syphilis. Chronic inflammation of the aortic wall leads to aneurysms.

In the absence of syphilis (treponema pallidum infection), type III Takayasu arteritis is a differential diagnosis.

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