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.

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".