A 60-year-old man presents with angina. He has no past medical history of heart disease. On questioning, the patient reveals that he had repeated sexually transmitted diseases in the past, including a painless chancre (a hard, round sore) on his penis, for which he never sought medical attention. RPR, VDRL slide test, and fluorescent treponemal antibody serologic tests (indicative of syphilis infection) are positive. Echocardiography and computed tomography of the heart are performed. The history of untreated syphilis suggests that these tests will most likely detect which of the following abnormalities?
A. Aortic valvular insufficiency and linear calcification along the ascending aorta
B. Bicuspid aortic valve with aortic stenosis
C. Large valvular vegetations from bacterial endocarditis
D. Right-sided heart failure from the carcinoid syndrome
E. Small fibrin deposits on the mitral valve from nonbacterial thrombotic (marantic) endocarditis
The answer is A. This is a case of syphilitic (luetic) aortitis. In syphilitic aortitis, the elastica of the aorta undergoes calcification and is replaced by fibrous tissue, resulting in dilation of the ascending aorta and separation of the aortic valve commissures, with resultant aortic insufficiency. Thus, echocardiography and computed tomography of the heart reveal calcification in a linear pattern along the ascending aorta, calcification in the coronary arteries (leading to anginal symptoms), and aortic valvular insufficiency.