After having been on the verge of eradication in 2000, with the lowest-ever rate of 2.1 per 100,000 population per year,  the worldwide incidence of syphilis has been increasing, culminating in the current rate of 5.1 cases per 100,000 population per year in Europe . This trend is mainly due to an increased number of cases among men who have sex with men, and to changes in sexual behaviour .
Known as the “great imitator” with a multitude of rare presentations, syphilis concerns almost all medical disciplines and should be included in the differential diagnosis of bizarre cases.
The spirochete Treponema pallidum is the agent of syphilis, and is probably limited to a human reservoir. Transmission predominantly occurs through sexual intercourse, although other transmission routes such as vertical transmission or mucous contact with the infectious chancre have been described.
Clinical presentation depends on the infection stage. Primary syphilis, with the indolent chancre, usually appears 21 days (10 to 90 days) after exposure and may spontaneously resolve after 1 to 4 months. Secondary syphilis corresponds to the dissemination of treponemal bacteria and occurs 3 to 6 months after the chancre with a macular rash on the trunk, face, palms and soles. Other manifestations include fever, headache, malaise, anorexia, diffuse lymphnodes, joint inflammation, hepatitis, uveitis, and hair loss. When left untreated, 30% of cases evolve within roughly 10 to 40 years to the tertiary stage, and manifest as infections of the central nervous system (neurosyphilis), skin and subcutaneous tissue (gummas), or as cardiovascular infections. While only 10 to 15% of patients will develop clinical signs,  cardiovascular involvement is the main cause of death attributable to syphilis [3, 4]. Although efforts to devise diagnostic tools for the early detection of cardiovascular involvement have been sought after with modest success using conventional radiography , post-mortem autopsies have historically been the only approach available to confirm cardiovascular syphilis [5–7]. Early studies, including the Tuskegee Study on African-American men showed evidence of aortitis in about half of autopsied subjects . However, in the sixties only 17% of syphilitic aortitis were diagnosed before necropsies . Since the advent of antimicrobial therapies, the focus has shifted from finding specific lesions caused by the syphilis to treatment with resolution of all lesions, specifically identified or not. As a consequence, the expected radiological findings have not been subject to large-scale studies, and the early diagnosis of syphilitic aortitis using modern radiological equipment has not been fully explored.