CTICasesSyphilitic Aortitis and Neurosyphilis
Imaging findings
Historical chest radiographs and angiograms show a massive, calcified ascending aortic aneurysm extending into the brachiocephalic artery. Contrast-enhanced brain CT/MRI demonstrates diffuse meningeal (sulcal) enhancement, consistent with neurosyphilis.
Key takeaways
Syphilitic aortitis classically manifests as a heavily calcified ascending aortic aneurysm (often described as having a 'tree bark' appearance on gross pathology). In tertiary syphilis, cardiovascular manifestations frequently coexist with neurological involvement (neurosyphilis), which presents as chronic syphilitic meningitis with leptomeningeal enhancement.
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