Syphilitic aneurysm formation

Aneurysms occur most commonly in the ascending aorta and with decreasing frequency in the arch and descending aorta.

The clinical features depend on the involvement of neighbouring organs:

• there may be pain - often sustained and boring in nature
• vertebrae, ribs and sternum may be eroded
• there may be visible pulsation in the neck with tracheal deviation
• the superior vena cava may become obstructed
• obstruction of the oesophagus may cause dysphagia
• compromise of the airway may cause stridor
• damage to the left recurrent laryngeal nerve may cause hoarseness

A syphilitic aneurysm may rupture into:

• left main bronchus
• left pulmonary artery
• left pleural space