The Significance of Calcification in the Ascending Portion of the Aortic Arch

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Abstract
In the gross pathologic specimen, the presence of arteriosclerosis of the aorta may give rise to confusion, masking a concomitant syphilitic aortitis (1). Radiologically, however, an accompanying arteriosclerosis with calcification makes demonstration of syphilitic involvement quite simple. Uncomplicated syphilitic aortitis is characterized morphologically by little or no fatty deposition and no calcification (1). Its clinical recognition is extremely difficult or even impossible in the absence of demonstrable aneurysmal dilatation. A diffuse dilatation of the entire arch without localized aneurysm formation cannot be definitely distinguished from arteriosclerosis of the aorta (11). A delayed diastolic recoil and an increased systolic pulsation of the aorta which can be observed fluoroscopically have been described as characteristic of syphilitic involvement but only rarely have I been able to convince myself that I was witnessing this phenomenon. Mallory states that calcification in the ascending portion of the aortic arch is unusual in arteriosclerosis unless the disease is far advanced (9). The earliest reference to calcification in association with syphilitic aortitis appears to have been made by Schatzki, who in 1942 stated that the presence of calcification is highly suggestive of that condition, particularly if the ascending aorta is involved, and that the presence of calcification proves rather than disproves the diagnosis (9). A rather high incidence of such calcification in the clinical material at this hospital and relevant reports in the literature (5, 12) stimulated the present study. The material reviewed was observed during the past four years. Most of the patients, therefore, are still alive. Eleven have died, and for 10 of these postmortem observations are available. All were found to have syphilitic aortitis with extensive arteriosclerosis and marked calcification. A total of 95 cases diagnosed as syphilitic aortitis were reviewed, and in 54 of these calcification was found in the ascending portion of the aortic arch. As a control, the roentgenograms of 163 cases of arteriosclerosis of the aorta diagnosed during the same period of time but without serologic or other evidence of syphilis were reviewed. A total of 258 cases were thus studied. The patients varied in age from fifty-one to seventy-seven years, averaging about sixty years. All were males, with a single exception (there was only one female ward in the hospital). The ratio of whites to Negroes was 4:1. Of the 54 patients with calcification in the ascending aorta, 30 showed evidence of aneurysm formation, while in 24 there was no definite localized aneurysmal dilatation. Five patients had negative serologic findings and denied a chancre or other knowledge of syphilis.

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