Remarkable spine erosion in cardiovascular syphilis - Computed tomography reconstruction of a century-old forensic case.

Abstract

This is the most intriguing museum specimen of cardiovascular syphilis, collected in the Forensic Museum founded by professor Milovan Milovanović (1884-1948) in 1923, the first professor of Forensic Pathology in the newly established University School of Medicine in Belgrade. We aimed to analyze the specimen of an autopsy case from the year 1929 in which severe thoracic spine erosion occurred due to syphilitic aneurism and to demonstrate findings by multi-detector computed tomography (MDCT). The specimen comprises an en-block-eviscerated heart, thoracic aorta, thoracic spine, and posterior segments of the ribs, with a partial section of the heart and a longitudinal section of the aorta. We performed histology and MDCT analyses almost a century after the autopsy and revised the original case documentation. The conducted analyses confirmed the characteristic pathology. Most importantly, MDCT imaging revealed intriguing destruction of the vertebral bodies by the pulsatile saccular aneurysm of the descending aorta. The calcified aneurysm led to the extensive irregular mechanically caused osteolysis of the anterior segments of the several vertebral corpora. After the analysis and revision of the original case documentation, we discussed these findings, as well as additional characteristic autopsy findings in syphilis-related deaths, some of which might be forgotten. The direct close contact of the syphilitic aortic aneurysm with the thoracic spine was preserved. By utilizing postmortem MDCT and 3D reconstruction, we better visualize the thoracic spine bone resorption and alteration: in the time of Milovanović, only roentgenography was available, providing less detail.