Successful repair of a syphilitic aortic arch aneurysm accompanied by serious cerebral infarction

Syphilitic aortic aneurysm

The aim of this study was to outline the clinical features of syphilitic aortic aneurysm. The study materials were based on a comprehensive literature review of publications on syphilitic aortic aneurysm published between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly in the ascending aorta in either a saccular or a fusiform shape. Syphilitic aortic aneurysm was often complicated by aortic valve insufficiency (in almost half of the patients), and by a coronary artery/ostium lesion in 16.5% of the patients. Aortic valve operation was necessary in one fourth, and coronary artery surgery accounted for less than one fifth of patients warranting a surgical treatment. Although there was no difference in the survival rates between the surgically and conservatively treated patients, an aggressive treatment should be performed when diagnosis is made due to the potential risks of aneurysm rupture and sudden death.

Aortic Aneurysm as a Complication of Granulomatosis with Polyangiitis Successfully Treated with Prednisolone and Cyclophosphamide: A Case Report and Review of the Literature

A 57-year-old Japanese man was admitted to the hospital with back pain and fever, multiple lung nodules, and abdominal aortic aneurysm (AAA). Laboratory tests performed at admission showed an increased proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) level. Video-associated thoracoscopic lung biopsy was performed; pathologic examination showed granulation tissue with necrosis and multinucleated giant cells. The diagnosis of granulomatosis with polyangiitis (GPA) was confirmed on the basis of the clinical presentation, laboratory findings, and lung biopsy. All symptoms were ameliorated, and the serum level of PR3-ANCA declined following treatment with prednisolone and cyclophosphamide. Although the association of GPA with AAA is rare, GPA may be included among the large vessel vasculitides that can give rise to aortic aneurysm.

Syphilitic aortic aneurysm with a pulmonary lesion: a case report and literature view

Introduction

Syphilitic aortic aneurysm (SAA) is caused by tertiary stage of syphilis infection. As the wide application of penicillin, this complication is becoming rarer than before. The SAA with lung cancer is a very rare disease in patient.

Case description

A 55-year-old male was admitted to the hospital complaining “progressive hoarseness for 3 months” and the patient has been diagnosed with syphilis after specific blood exams, computed tomography angiography (CTA) and 3dimensional (3D) reconstructions of cardiac vessels. Chest computed tomography displayed an anomalous soft tissue mass with slightly lobular borders in the peripheral segment of the left lower lobe. According to the aneurysm’s and lung neoplasm’s location, several procedures could be selected such as aneurysm resection with artificial graft replacement or endovascular stenting under angiography. Then, the lesion was removed by lobectomy using video-assisted thoracic surgery.

Discussion and Evaluation

Cardiovascular syphilis remains a major cause of ascending aortic aneurysm. The clinical manifestations of patients with syphilis aortic aneurysm could vary. Aortic imaging is necessary to confirm the diagnosis and to determine the anatomic extent of the aneurysm. The differential diagnosis of the lesion in the pulmonary is mostly the tumor like pulmonary lesion, Pulmonary syphilis. Some studies showed that thoracic aortic aneurysm has been reduced by using penicillin. However, penicillin therapy alone is not always sufficient in recent years. The serologic response to treatment is more significant and faster in patients treated with the enhanced regimen compared to patients treated with the standard penicillin regimen.

Conclusions

Syphilitic aortic aneurysm with lung cancer is a rare disease in patient. Chest CT and CTA scans are able to indicate the presence of SAA. Pathological analysis is an effective method to clarify the diagnosis of the lung lesion. The interventional therapy and surgery are regular treatment method for SAA and pulmonary neoplasm.