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The Great Masquerader: Coronary Occlusion From Thrombus in Ascending Aortic Aneurysm Causing Anterior-Wall STEMI With

Wiwat Kanjanarutjawiwat1, Sarunpong Pibalyart, Paruepong Makarasen

  • 1Cardiology Unit, Department of Internal Medicine, Phrapokklao Hospital Chanthaburi, 38 Leabnean Road, Chanthaburi, Thailand 22000. mdwiwat@gmail.com.

The Journal of Invasive Cardiology
|October 6, 2022
PubMed

Insights

A rare case of syphilitic aortitis led to a large thrombus in the ascending aorta, causing myocardial infarction and death. Early recognition of syphilitic aortic aneurysms is crucial for preventing such fatal outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Pathology

Background:

  • Tertiary syphilis is a rare condition in modern medicine.
  • Syphilitic aortitis can lead to ascending aortic aneurysms.

Observation:

  • A 55-year-old man presented with chest pain due to a thrombus in the ascending aorta.
  • The thrombus occluded the left coronary artery ostia, causing myocardial infarction.

Findings:

  • Autopsy revealed an ascending aortic aneurysm with syphilitic aortitis.
  • Atherosclerosis with ulcerative plaque and endarteritis were noted.
  • A large mobile thrombus was found in the left coronary cusp, extending into the aorta.

Implications:

  • This case highlights a rare cause of ST-elevation myocardial infarction.
  • Early diagnosis of syphilitic aortic aneurysms is critical for preventing coronary artery complications.
  • Recognizing thrombus formation in syphilitic aortic aneurysms is key to timely intervention.

Keywords:
percutaneous coronary interventionacute coronary syndromeaortic aneurysmthrombus

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