Syphilis x-ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]; Tarek Nafee, M.D. [3]; Nate Michalak, B.A.

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## Overview

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Chest x-ray is not routinely used to detect syphilis. However, complications associated with syphilis may be detected incidentally on x-ray. Cardiovascular manifestations of syphilis may be seen as a non-specific widening of the aortic or mediastinal silhouettes on PA and lateral chest x-ray.[1][2] Linear calcification of the ascending aorta is an almost pathognomonic finding of syphlitic aortitis.[3] This may prompt the clinician to order further imaging studies for confirmation. Additionally, on chest x-ray, secondary pulmonary syphilis may be characterized by the bilateral infiltrates, pleural effusion, subpleural nodules, and lymphadenopathy.[4][5][6][7][8] X ray findings may also include osteolytic bone lesions.[9]

## X-ray

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X-ray findings in syphilis are largely non-specific and may be found incidentally. Common incidental x-ray findings of syphilis may include:

### Pulmonary

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On chest x-ray, secondary pulmonary syphilis may be characterized by the following:[4][5][6][7][8]

* Bilateral infiltrates
* Pleural effusion
* Subpleural nodules
* Lymphadenopathy

### Cardiac

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Chest x-ray is not routinely used to detect thoracic manifestations of syphilis. However, thoracic aortic aneurysms associated with syphilis may be detected incidentally as a widening of the aortic or mediastinal silhouettes on PA and lateral chest x-ray. Accurate assessment of the exact size is difficult and further imaging studies are required to do so.[1][2] Linear calcification of the ascending aorta is an almost pathognomonic finding of syphlitic aortitis.[3]

### Bone

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X-ray findings may also include osteolytic bone lesions.[9]

## References

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1. ↑ 1.0 1.1 https://radiopaedia.org/articles/thoracic-aortic-aneurysm. Accessed on September 28th, 2016.
2. ↑ 2.0 2.1 https://radiopaedia.org/articles/ascending-aortic-aneurysm. Accessed on September 28th, 2016.
3. ↑ 3.0 3.1 Dabis R, Radcliffe K (2011). "Is it useful to perform a chest X-ray in asymptomatic patients with late latent syphilis?". Int J STD AIDS. 22 (2): 105–6. doi:10.1258/ijsa.2010.010248. PMID 21427433.
4. ↑ 4.0 4.1 Biro L, Hill AC, Kuflik EG (1968). "Secondary syphilis with unusual clinical and laboratory findings". JAMA. 206 (4): 889–91. PMID 4175712.CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 David G, Perpoint T, Boibieux A, Pialat JB, Salord H, Devouassoux M; et al. (2006). "Secondary pulmonary syphilis: report of a likely case and literature review". Clin Infect Dis. 42 (3): e11–5. doi:10.1086/499104. PMID 16392072.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ 6.0 6.1 Burger HG, Baker HW, Buckler HM, Healy DL, Kovacs GT (1988). "Advances in reproductive medicine: Australian contributions". Aust N Z J Med. 18 (3): 263–77. PMID PMC3056368 : PMC3056368 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
7. ↑ 7.0 7.1 Coleman DL, McPhee SJ, Ross TF, Naughton JL (1983). "Secondary syphilis with pulmonary involvement". West J Med. 138 (6): 875–8. PMC 1010855. PMID 6613117.CS1 maint: Multiple names: authors list (link)
8. ↑ 8.0 8.1 Geer LL, Warshauer DM, Delany DJ (1985). "Pulmonary nodule in secondary syphilis". Australas Radiol. 29 (3): 240–2. PMID 4074225.CS1 maint: Multiple names: authors list (link)
9. ↑ 9.0 9.1 Shore RN, Kiesel HA, Bennett HD (1977). "Osteolytic lesions in secondary syphilis". Arch Intern Med. 137 (10): 1465–7. PMID 921426.CS1 maint: Multiple names: authors list (link)

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