title: Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.
abstract: Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm.
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan. yuji-sekine@kif.biglobe.ne.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fujikawa
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai ward, Kawasaki, 212-0014, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Sasaguri
mesh_terms: D000785:Aneurysm, Infected / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013589:Syphilis, Cardiovascular / Q000150:complications / Q000601:surgery*; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014683:Vena Cava, Superior / Q000601:surgery*
keywords: Aorta to superior vena cava fistula; Giant aneurysm; Superior vena cava syndrome; Syphilitic aneurysm; Total arch replacement