Author + information
- Received January 31, 2011
- Accepted February 10, 2011
- Published online January 3, 2012.
A previously healthy 38-year-old man presented to our hospital with sudden-onset dyspnea, sharp, stabbing chest pain, and a clinical picture of cardiogenic shock. Echocardiography revealed a severely dilated ascending aorta beyond the sinotubular junction (A, Online Video 1), with moderate aortic insufficiency (Online Video 2). There was a large pericardial effusion with thrombus inside (Online Videos 1 and 3). Computed tomographic angiography was performed, with a presumptive diagnosis of aortic dissection with rupture into the pericardium, and demonstrated a dilated ascending aorta 100 mm in diameter (B, C) compressing the right atrium, with no visible intimal tear or flap.
The patient underwent an emergent Benthall procedure. Intraoperatively, no intimal tear or dissection was noted. Pathology revealed predominantly lymphoplasmacytic inflammatory cell infiltrates around the vaso vasorum of the adventitia (D) in the resected aortic segment, suggesting that tamponade resulted from tearing of the adventitial vessels. Blood work was positive for Treponema pallidum hemagglutination antibody. A diagnosis of tertiary syphilis complicated by aortic aneurysm was made.
- Received January 31, 2011.
- Accepted February 10, 2011.
- American College of Cardiology Foundation