An autopsy on a 55-year-old man who died of congestive heart failure shows dilatation of the aortic root with concentric intimal wrinkling and depression of the overlying atherosclerotic plaque, giving a 'tree-bark' appearance. The aortic valve ring is dilated with regurgitation. The most likely diagnosis is:

• A Takayasu arteritis
• B Syphilitic aortitis ✓
• C Giant cell arteritis of the aorta
• D Marfan syndrome with cystic medial degeneration

Explanation

Syphilitic aortitis, a manifestation of tertiary syphilis, involves the vasa vasorum of the ascending aorta with obliterative endarteritis and plasma cell infiltrates, weakening the media and causing aneurysmal dilatation. Scarring produces the characteristic tree-bark intima, and dilatation of the aortic root causes aortic regurgitation. Takayasu and giant cell arteritis involve the aortic arch branches with granulomatous inflammation, and Marfan causes cystic medial degeneration without tree-bark scarring.

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.