Syphilitic Aortitis with Coronary Ostial Involvement: AIRP Best Cases in Radiologic-Pathologic Correlation.
Radiographics. 2017 Mar-Apr;37(2):407-412. doi: 10.1148/rg.2017160168.
Lian K1, Lee L1, Machan L1.
In 2014, a 58-year-old man, a Chinese immigrant, presented to the emergency department, having had symptoms of angina for 3 days. His initial physical examination, electrocardiographic results, and troponin level were normal. In the emergency department, the patient’s clinical status deteriorated rapidly: he had worsening chest pain, shortness of breath, and a syncopic episode. Results of repeat electrocardiography indicated ST depressions in the inferolateral and anterolateral leads. His oxygen saturation range decreased from 90%–100% to 70%–80% within minutes, and repeat physical examination revealed pulmonary edema. The patient was promptly intubated owing to pulmonary edema and suspicion of cardiogenic shock. Immediate cardiac catheterization revealed greater than 90% obstruction of the left coronary artery ostium; the remaining coronary arteries were normal. The ascending aorta was found to be dilated and irregular. No endovascular treatment was performed. Results of subsequently performed computed tomographic (CT) angiography indicated aortitis as the cause of the coronary ostial stenosis. Cardiac surgery involving ascending aortic arch replacement with coronary bypass grafts was performed. Final histopathologic analysis results confirmed the diagnosis of syphilitic aortitis. The patient received a 10-day course of penicillin and had an uneventful recovery.