Answer to Pathology MCQ 487
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Syphilitic (Luetic) aneurysms
Occurs exclusively in late tertiary syphilis. Almost always occur in the thoracic aorta and aortic arch. When luetic aortitis involves the aortic valve ring, the ring dilates causing aortic valvular insufficiency. Since the organisms lodge in the vasa vasorum of the aorta, there is an obliterative endarteritis of these vessels rimmed by an infiltrate of lymphocytes and plasma cells. With the subsequent inflammation there is destruction of elastic fibers within the aortic wall and scar formation. As the scars contract, the aortic intima is retracted leading to wrinkling or the "tree-barking" change of the intima.
Syphilitic aneurysms can attain immense size contributing to other clinical problems including
1. respiratory difficulty due to encroachment on lungs and airways
2. difficulty in swallowing due to compression of the esophagus
3. persistent cough due to irritation of or pressure on the recurrent laryngeal nerves
4. pain caused by erosion of bone, e.g. ribs and vertebral column.
Category: Pathology MCQs
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