A 58-year-old man with a history of treated syphilis presents with severe chest pain and a diastolic murmur. Imaging shows a fusiform aneurysm of the ascending aorta. Which finding is characteristic of this condition?

• A Cystic medial degeneration with pools of basophilic ground substance
• B Tree-bark appearance of the intimal surface with destruction of the vasa vasorum and medial elastic fibers ✓
• C Infrarenal saccular dilatation with mural thrombus
• D Granulomatous inflammation of the aortic arch branches in a young patient

Explanation

Syphilitic (luetic) aortitis classically involves the ascending aorta. Treponemal infection of the vasa vasorum causes obliterative endarteritis, ischemia of the media, destruction of elastic fibers and smooth muscle, and scarring, producing the wrinkled tree-bark intima and aneurysmal dilation. Complications include aortic regurgitation from annular dilation and coronary ostial stenosis. Cystic medial degeneration is seen in Marfan syndrome and dissection, infrarenal saccular aneurysms are atherosclerotic, and arch branch granulomatous inflammation describes Takayasu arteritis.

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.