Aortic-pulmonary fistulization – An unusual complication of syphilitic aortic aneurysm

In the natural history of all aneurysms in general thickening of the wall. The intima showed small, and aortic aneurysms in particular, rupture is the most gelatinous, translucent grey-white plaques separated common and dreaded complication. Aneurysms of by vertical scars. Such changes, ‘tree-bark’ appearthe thoracic portions of the aorta can rupture into the ance, were also seen in the arch and proximal 1.5 cm pericardial cavity, mediastinum or lungs. Rupture into of the thoracic aorta. The gross impression of the pulmonary trunk is an unusual and rare complicasyphilitic aortitis was confirmed on histology. VDRL tion. One such case in a 40-year-old male with was also positive in the post-mortem serum sample. syphilitic ascending aortic aneurysm is reported. Besides aortic regurgitation, the added complication was a large saccular aneurysm (5 cm diameter) which arose 2.5 cm above the sino-tubular junction. 1. Case report The lumen contained laminated thrombi and the wall was irregularly thinned out. Interestingly, the A 40-year-old man was hospitalised for progresaneurysm communicated with the right pulmonary sive dyspnoea, oedema feet and palpitations for past artery through a small, 0.5 cm opening (Fig. 1). ten days. On examination, the pulse was 82 per There was multiple large foci of haemorrhage in the minute and regular. The blood pressure was 140/60 right lung. mmHg. There was ventricular heave and thrill in the left second intercostal space in the mid-clavicular line with a pansystolic murmur on auscultation. A clinical 2. Discussion diagnosis of a subpulmonic ventricular septal defect or patent ductus arteriosus was entertained. The Rupture of an aortic aneurysm into the pulmonary patient had a fall in the bathroom and was found to artery with a fistulous communication is a rare event be acutely breathless and cyanosed. Efforts at resusciwith an incidence around 3% [1]. It occurs secondary tation failed. to trauma [2], aortic dissection [3] and syphilitic A complete autopsy was performed. The heart aortitis [4,5]. The reported case was a 40-year-old weighed 690 g and had moderate concentric left man with syphilitic aortitis and a large saccular ventricular hypertrophy. The aortic annulus was aneurysm of the ascending aorta. The rarity of dilated with separation of commissures and rounding cardiovascular syphilitis has been frequently stressed of the cuspal free margins, indicative of aortic in Western literature; however in India, it continues to regurgitation. The ascending aorta was dilated with remain one of the commonest causes of aortic