A 61-year-old man comes to the physician because of a 5-month history of sharp, shooting pain in both legs. Twenty years ago, he had a painless ulcer on his penis that resolved without treatment. He has no history of serious illness. Examination shows small pupils that constrict with accommodation but do not react to light. Sensation to pinprick and light touch is decreased over the distal lower extremities. Patellar reflexes are absent bilaterally. His gait is unsteady and broad-based. This patient is at increased risk for which of the following complications?

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Eductional Objective: Tertiary syphilis can result in thoracic aortic aneurysm. If the aneurysm compresses adjacent structures and dilates the aortic valve ring, a murmur and mediastinal widening might be present. The pathogenesis begins with vasa vasorum endarteritis and obliteration, resulting in inflammation, ischemia, and weakening of the aortic adventitia. Fluorescent treponemal antibody absorption testing is specific for syphilis.

A 61-Year-Old Man Comes to the Physician Because of a 5-Month