MEDICINE

162.TREE BARK APPEARENCE SEEN IN

A.SYPHILITIC ANEURYSM
B.ATHEROSCLEROTIC ANEURYSM
C.BERRY ANEURYSM
D.AORTIC ANEURYSM

ANS:SYPHILITIC ANEURYSM

SYPHILITIC

Before the advent of antibiotics, syphilis was the most common cause of aneurysms of the ascending aorta. Syphilitic infection produces aortitis and an obliterative endarteritis. Destruction of the vasa vasorum causes degeneration of the medial elastic fibers.  The intima in syphilitic aortas classically is described as having a “tree-bark” appearance, with wrinkles, ridges, and pearly plaques. The disease most commonly affects the ascending aorta and aortic arch . There may be patchy or diffuse involvement of the aorta, and both saccular and fusiform aneurysms are observed. Inflammatory changes surrounding the coronary ostia may lead to clinically significant coronary arterial obstruction. Anti-syphilitic drug therapy does not reverse the vascular lesions or consequences. Patients with syphilis commonly have other risk factors associated with aneurysm formation; thus, aneurysms in patients who are seropositive for syphilis may not be caused by infection with Treponema pallidum.