A 50-year-old man presented with a 1-month history of backache. The clinical examination was remarkable for tenderness in the thoracic spine, early diastolic murmur in the aortic area, and loud aortic component of second heart sound. Chest radiography showed mediastinal widening (arrows) suggestive of an aneurysm of the descending thoracic aorta (A). Two-dimensional transthoracic echocardiography (B, Online Video 1) and aortic root angiography (C, Online Video 2) revealed moderate aortic regurgitation with a dilated ascending aorta. Coronary angiography showed critical stenosis (arrow) of the ostial left main coronary artery (D, Online Video 3). Computed tomography confirmed an aneurysm of the descending thoracic aorta, which was filled with thrombus and eroding D3 to D7 vertebral bodies (E and F). These features were suggestive of syphilitic cardiovascular disease and confirmed with diagnostic titers on a Treponema pallidum hemagglutination assay. The patient was treated with benzathine penicillin and referred for early aneurysm repair, B entail procedure, and coronary artery bypass surgery, followed by spine stabilization.
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