A 60-year-old man with a history of untreated syphilis presents with dyspnea and a diastolic murmur best heard at the right sternal border. Chest X-ray shows a dilated ascending aorta. What is the most likely underlying pathology?

• A Syphilitic aortitis ✓
• B Mitral valve prolapse
• C Infective endocarditis
• D Aortic dissection

Explanation

Syphilitic aortitis involves the ascending aorta and aortic arch, causing aortic dilation, aortic regurgitation, and aneurysm formation. It results from obliterative endarteritis of the vasa vasorum. The diastolic murmur at the right sternal border indicates aortic regurgitation. Infective endocarditis would cause fever and changing murmurs. Aortic dissection presents with acute tearing chest pain and asymmetric blood pressures.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.