Comment on Aortic Aneurysm: Dissection from the Root to Pelvis

Sep 28, 2026

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Letter to the editor discussing a reported rare case of aortic aneurysm in a Taiwanese woman with Marfan syndrome. The author argues the aneurysm may be attributable to cardiovascular manifestations of untreated syphilis rather than solely to Marfan syndrome, describing syphilis progression, latent/tertiary cardiovascular complications, and histopathologic mechanisms leading to aortic dilation. The letter notes lack of a syphilis diagnostic panel in the original report and suggests that identifying syphilis would reclassify the case as co-occurring Marfan syndrome and syphilis-related aortic aneurysm.

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| Correspondence | | --- | | | Comment on Aortic Aneurysm: Dissection from the Root to Pelvis Mahmood Dhahir Al‑Mendalawi* Department of Paediatrics, Al‑Kindy College of Medicine, University of Baghdad, Baghdad, Iraq Dear Editor, In January–March 2025 issue of the distinguished Journal of Medical Ultrasound, Jhang et al.[1] reported a rare case of aortic aneurysm (AA) in a Taiwanese woman with Marfan syndrome (MS) . That case report importantly enriches the literature with MS‑associated AA. However, we believe that Jhang et al.[1] ought to take into consideration an important factor contributing to the occurrence of AA before attributing the reported AA to the pathological consequences of MS. It is noteworthy that syphilis, a sexually transmitted disease, usually develops in different stages (primary, secondary, latent, and tertiary) . Each stage has various clinical pictures and could last for many years. In the latent or tertiary stage, it is associated with numerous cardiovascular manifestations, such as aneurysm formation, valve regurgitation/or stenosis, and coronary vasculitis. Such advanced manifestations will develop when the diagnosis has not been established, and/or proper therapy has not been introduced in the early stage of the infection.[2] Histologically, syphilis triggers obliterativeendarteritis of the small arteries of the vasa vasorum, escalating ischemic injury of the aortic media and consequent aneurysmal dilation.[3] Syphilis is a worrisome health problem in Taiwan. The available statistic showed that around 10 thousand syphilis confirmed cases were reported in 2023 Received: 21‑03‑2025 Accepted: 02‑05‑2025 Available Online: 19‑12‑2025 | Access this article online | | | --- | --- | | Quick Response Code:
| Website:
[https://journals.lww.com/jmut](https://journals.lww.com/jmut) | | | DOI:
10.4103/jmu.JMU‑D‑25‑00039 | across the country, up from about 9700 in the previous year. [4] Regrettably, Jhang et al.[1] did not consider the diagnostic panel for syphilis in the studied patient. If that panel was to unveil syphilis, the case in question could be surely regarded a novel case report in the literature of AA in a patient with concomitant MS and syphilis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. RefeRences 1. Jhang LS, Chao AS, Chien CW. Aortic aneurysm: Dissection from the root to pelvis. J Med Ultrasound 2025;33:64‑6 . 2. Kallash M, Frishman W. Cardiovascular Syphilis. Cardiol Rev 2025. doi: 10. 1097/CRD.0000000000000863. 3. Chaudhary F, Faghihimehr A, Subedi Y, Hodanazari SM, Yousaf MN. Syphilitic aortic aneurysm: A rare entity in the era of antibiotics. Cureus 2021;13:e13647 . 4. Statista. Number of Confirmed Cases of Syphilis in Taiwan from 2013 to 2023. Available from: [https://www.statista.com/](https://www.statista.com/)[ ](https://www.statista.com/)statistics/934735/taiwan‑number‑of‑syphilis‑cases/ . [Last accessed on 2025 Mar 21] . Address for correspondence: Prof. Mahmood Dhahir Al‑Mendalawi, Department of Paediatrics, Al‑Kindy College of Medicine, University of Baghdad, P. O. Box 55302, Baghdad Post Office, Baghdad, Iraq. E‑[mail: mdalmendalawi@yahoo.com](mail: mdalmendalawi@yahoo.com) This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. For reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](contact: WKHLRPMedknow_reprints@wolterskluwer.com) How to cite this article: Al‑Mendalawi MD. Comment on aortic aneurysm: Dissection from the root to pelvis. J Med Ultrasound 2025;33:411 . © 2025 Journal of Medical Ultrasound | Published by Wolters Kluwer-Medk

FAQs

Why does the author challenge the original attribution of the aortic aneurysm to Marfan syndrome?

The author suggests that syphilis can produce cardiovascular manifestations, including aneurysm formation, and that the contributing factor may not have been considered.

What syphilis-related mechanism does the letter describe for aortic aneurysm development?

It describes obliterative endarteritis of small arteries in the vasa vasorum, leading to ischemic injury of the aortic media and aneurysmal dilation.

What key limitation did the author identify in the original case report?

The author states that Jhang et al. did not consider a diagnostic panel for syphilis in the studied patient.

Sep 28, 2026

Uploaded by hdkawk