Skip to main content


Log in

Early recognition of aortitis of the aorta ascendens with 18F-FDG PET/CT: syphilitic?

  • Case Based Review
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript


We present the case of a 42-year-old woman known with a human leukocyte antigen B27 positive ankylosing spondylitis. Despite treatment with a tumor necrosis factor blocking agent, the patient was not pain free and inflammation markers remained elevated. An 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed in an attempt to exclude possible other inflammatory processes. The 18F-FDG PET/CT revealed increased metabolic activity in the ascending aortic wall, which appeared unexpectedly related to late syphilis. Based on this case and existing literature on this subject, we come to the conclusion that 18F-FDG PET/CT can help in an early establishment of syphilitic aortitis before the possible life-threatening sequelae of syphilitic aortitis occur.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Roberts WC, Ko JM, Vowels TJ (2009) Natural history of syphilitic aortitis. Am J Cardiol 104(11):1578–1587

    Article  PubMed  Google Scholar 

  2. Tavora F, Burke A (2006) Review of isolated ascending aortitis: differential diagnosis, including syphilitic, Takayasu's and giant cell aortitis. Pathology 38(4):302–308

    Article  PubMed  Google Scholar 

  3. Eg C, Danbolt N (1955) The Oslo study of the natural history of untreated syphilis: an epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material: a review and appraisal. J Chronic Dis 2(3):311–344

    Article  Google Scholar 

  4. Rockwell DH, Yobs AR, Moore MB Jr (1964) The Tuskegee study of untreated syphilis; the 30th year of observation. Arch Intern Med 114:792–798

    Article  PubMed  CAS  Google Scholar 

  5. Tomey MI, Murthy VL, Beckman JA (2011) Giant syphilitic aortic aneurysm: a case report and review of the literature. Vasc Med 16(5):360–364

    Article  PubMed  Google Scholar 

  6. Saraiva RS, Cesar CA, Mello MA (2010) Syphilitic aortitis: diagnosis and treatment. Case report. Rev Bras Cir Cardiovasc 25(3):415–418

    Article  PubMed  Google Scholar 

  7. Liu J, Yuan Q, Golamaully R, Gong T (2011) Syphilitic aortitis complicated by multiple aortic aneurysms: findings of multidetector CT. Int J Cardiovasc Imaging 27(5):695–699

    Article  PubMed  CAS  Google Scholar 

  8. Vaideeswar P (2010) Syphilitic aortitis: rearing of the ugly head. Indian J Pathol Microbiol 53(4):624–627

    Article  PubMed  Google Scholar 

  9. Acar Z, Agac MT, Demirbas M, Kurt D (2012) Giant syphilitic aortic aneurysm presenting with pericardial tamponade as an initial sign. J Am Coll Cardiol 59(1):e1

    Article  PubMed  Google Scholar 

  10. Kobayashi T, Yagi T, Murakami M, Jinbo M, Saito S, Takahashi T et al (2011) Staged surgical repair for extensive cardiovascular damage by syphilis. Ann Thorac Surg 92(4):1503–1506

    Article  PubMed  Google Scholar 

  11. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    PubMed  CAS  Google Scholar 

  12. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL et al (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33(2):160–172

    Article  PubMed  CAS  Google Scholar 

  13. Heggtveit HA (1964) Syphilitic aortitis. A clinicopathologic autopsy study of 100 cases, 1950 to 1960. Circulation 29:346–355

    Article  PubMed  CAS  Google Scholar 

  14. Jackman JD Jr, Radolf JD (1989) Cardiovascular syphilis. Am J Med 87(4):425–433

    Article  PubMed  Google Scholar 

  15. Rojo-Leyva F, Ratliff NB, Cosgrove DM III, Hoffman GS (2000) Study of 52 patients with idiopathic aortitis from a cohort of 1,204 surgical cases. Arthritis Rheum 43(4):901–907

    Article  PubMed  CAS  Google Scholar 

  16. Palazzi C, Salvarani C, D'Angelo S, Olivieri I (2011) Aortitis and periaortitis in ankylosing spondylitis. Joint Bone Spine 78(5):451–455

    Article  PubMed  Google Scholar 

  17. Dunphy MP, Freiman A, Larson SM, Strauss HW (2005) Association of vascular 18F-FDG uptake with vascular calcification. J Nucl Med 46(8):1278–1284

    PubMed  Google Scholar 

  18. Hooisma GA, Balink H, Houtman PM, Slart RH, Lensen KD (2012) Parameters related to a positive test result for FDG PET(/CT) for large vessel vasculitis: a multicenter retrospective study. Clin Rheumatol 31(5):861–871

    Article  PubMed  CAS  Google Scholar 

  19. Balink H, Bruyn GA (2007) The role of PET/CT in Cogan's syndrome. Clin Rheumatol 26(12):2177–2179

    Article  PubMed  CAS  Google Scholar 

  20. Taniguchi Y, Kumon Y, Arii K, Tsugita M, Fukumoto M, Ohnishi T et al (2010) Clinical implication of 18F-fluorodeoxyglucose PET/CT in monitoring disease activity in spondyloarthritis. Rheumatology (Oxford) 49(4):829

    Article  Google Scholar 

  21. Nandwani R, Evans DT (1995) Are you sure it's syphilis? A review of false positive serology. Int J STD AIDS 6(4):241–248

    PubMed  CAS  Google Scholar 

  22. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H (2009) IUSTI: 2008 European Guidelines on the Management of Syphilis. Int J STD AIDS 20(5):300–309

    Article  PubMed  CAS  Google Scholar 

  23. Kosters K, Bleeker-Rovers CP, van Crevel R, Oyen WJ, Van der V (2005) Aortitis diagnosed by F-18-fluorodeoxyglucose positron emission tomography in a patient with syphilis and HIV coinfection. Infection 33(5–6):387–389

    Article  PubMed  CAS  Google Scholar 

Download references



Author information

Authors and Affiliations


Corresponding author

Correspondence to H. Balink.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balink, H., Spoorenberg, A., Houtman, P.M. et al. Early recognition of aortitis of the aorta ascendens with 18F-FDG PET/CT: syphilitic?. Clin Rheumatol 32, 705–709 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: