• Introduction 
    • tertiary syphilis (T. pallidium) disrupts the vasa vasorum of the ascending and transverse aorta
      • destruction of vasa vasorum caused by vasculitic phenomenon (endarteritis obliterans)
      • plasma cell infiltrate in wall
    • normally seen in men 40-55 years
  • Presentation
    • dilation of the aorta and valve ring
      • resulting in aortic valve regurgitation
    • may see calcification of the aortic root and ascending aortic arch 
      • leads to "tree bark" appearance of the aorta
    • can result in aneurysm of the ascending aorta
      • may present as a brassy cough due to pressure on ascending laryngeal nerve



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