Huge Syphilitic Aneurysm of the Thoracic Aorta Complicated with Airway Obstruction and Superior Vena Cava Syndrome

Takashi Yasukawa＊	Susumu Manabe＊	Daiki Hirayama＊
Daisuke Hiraoka＊	Sotaro Katsui＊	Hidetoshi Uchiyama＊
Masahiro Onuki＊	Kazunobu Hirooka＊

（Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan）

Today, syphilitic aortic aneurysm is rarely diagnosed due to widespread use of penicillin for early syphilis. Large aneurysms can be symptomatic by compressing on adjacent organs. We report a case of a huge syphilitic aneurysm of the thoracic aorta complicated with airway obstruction and superior vena cava syndrome. A 62-year-old man presented with acute severe dyspnea and distention of superficial veins. Contrast-enhanced computed tomography revealed an aneurysm of the ascending aorta extending to the transverse arch the diameter of which was 90mm. The aneurysm compressed the bilateral main bronchi and superior vena cava. We performed an emergency operation because respiratory failure persisted despite the support of a ventilator. Since the aneurysm eroded the sternum, median sternotomy was performed under hypothermic circulatory arrest. Dissecting the aneurysm was complicated due to dense adhesion. Ascending aorta and partial arch replacement with reconstruction of the brachiocephalic trunk was successfully performed with antegrade cerebral perfusion. Postoperative computed tomography demonstrated that compression of the bilateral main bronchi was released. The result of preoperative syphilitic serologic test was strongly positive, and pathological findings of the aneurysm wall specimen was compatible with syphilitic aneurysm. Following treatment with benzyl penicillin for 14 days, the patient was discharged on the 19th postoperative day without specific complications.

 

Jpn. J. Cardiovasc. Surg. 47:148-152（2018）

Keywords：syphilitic aortic aneurysm;airway obstruction;superior vena cava syndrome;main bronchus compression