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THE RADIOLOGICAL FEATURES OF SYPHILITIC AORTIC INCOMPETENCE

1959; BMJ; Volume: 21; Issue: 2 Linguagem: Inglês

10.1136/hrt.21.2.162

1468-201X

William G. Smith, J.C. Léonard,

Syphilis Diagnosis and Treatment

Linear calcification of the ascending aorta is an almost specific radiological sign of syphilitic aortitis.If carefully sought, it can be found in about 40 per cent of patients with this disease (Thorner and Carter, 1948).It is therefore a valuable aid in the differential diagnosis of aortic incompetence, but even now its value is not fully recognized.Stroud (1950) and Scherf and Boyd (1948) do not mention the sign in their text-books.In his recent text-book on 'Principles of Chest X-ray Diagnosis', Simon (1956) does not specify the site of calcification of the aorta in syphilitic aortitis.In the course of a recent extensive survey of syphilitic aortic incompetence (Leonard and Smith, 1957; Smith, 1957) the value of radiological examination was apparent; an attempt is here made to assess more fully the contribution that this investigation can make towards accurate clinical diagnosis. MATERIAL AND METHODSThe clinical features, prognosis, and response to treatment were studied in a series of 422 patients with syphilitic aortic incompetence.The diagnosis was made during the years 1926-57 at the National Heart Hospital; The London Hospital; The Middlesex Hospital; The Royal Infirmary, Aberdeen; The Norfolk and Norwich Hospital; St. Bartholomew's Hospital; and the Royal Infirmary, Cardiff.The criteria of selection were strict and have been previously detailed (Leonard and Smith, 1957).For the purpose of studying prognosis all patients with saccular aneurysm and gross aortic dilatation were excluded.Of the 123 survivors, 50 have been personally examined on one or more occasions.The chest radiograms of 83 patients have been carefully studied.These include the 50 patients, that were personally examined, and a further 33, whose radiograms were available and were technically satisfactory.All except 10 of the patients had two postero-anterior (P-A) films taken, one the conventional six-foot teleradiogram and the second an over-penetrated teleradiogram with a stationary grid.The second P-A view is very helpful in detecting calcium in the aorta or else- where and in outlining the size and shape of the aorta.It also shows the shadow of an enlarged left atrium, lying within the right border of the heart.Bilateral oblique views were taken in 30 patients.Screening with a barium swallow was carried out in 35 patients.Serial radiograms were available in the majority.The following points were examined in the radiograms.(1) The cardio-thoracic ratio.(2) The size and shape of the aorta.The size was graded as normal, slightly dilated, mode- rately dilated, or considerably dilated.(3) The size of the left ventricle similarly graded.